Abstract
BACKGROUND: Haemodialysis (HD) is associated with the acute loss through the dialysis membrane of biochemical factors either enhancing [folic acid (F)] or impairing [asymmetric dimethylarginine (ADMA)] arterial function. Changes in these opposing factors might explain the absence of significant modifications in arterial function during HD. We speculated that intra-HD, instead of pre-HD, F administration would provide beneficial effects on arterial wave reflections and endothelial function by preventing HD-induced F loss. METHODS: Arterial wave reflections [augmentation index (AIx), pulse-wave analysis], endothelium-dependent vasodilation (salbutamol-mediated changes in AIx) and plasma concentrations of F and ADMA were measured pre-HD and end-HD in 10 patients (age 67.7 +/- 10.3 years). Each subject received F 5 mg either pre-HD or intra-HD in two separate studies 2-4 weeks apart, in an open-label randomized cross-over trial. RESULTS: Pre-HD F administration did not prevent significant reductions in F during HD (end-HD vs. pre-HD, -865 +/- 465 nmol l(-1), P <0.001), but no significant changes in AIx (+1.4 +/- 5.7%) or salbutamol-mediated AIx modifications (+0.4 +/- 5.5%) were observed. By contrast, intra-HD F administration was associated with significant increases in F (+298 +/- 283 nmol l(-1), P = 0.010) and a significant reduction of AIx (-4.7 +/- 7.2%, P = 0.013), but no effects on salbutamol-mediated AIx changes (+1.5 +/- 4.4%). There was a trend towards greater HD-induced reductions in plasma ADMA concentrations with intra-HD F administration (P = 0.066). CONCLUSIONS: Intra-HD F administration reduces arterial wave reflections but not endothelial function during HD. Given the prognostic significance of arterial wave reflections in HD patients, the timing of F administration is important in the design of interventional trials in this cohort.
Original language | English |
---|---|
Pages (from-to) | 717-722 |
Number of pages | 6 |
Journal | British Journal of Clinical Pharmacology |
Volume | 66 |
Issue number | 5 |
Early online date | 11 Jul 2008 |
DOIs | |
Publication status | Published - Nov 2008 |
Keywords
- aged
- albuterol
- arginine
- cross-over studies
- drug administration schedule
- endothelium, vascular
- female
- folic acid
- humans
- kidney failure, chronic
- male
- middle aged
- radial artery
- renal dialysis
- statistics, nonparametric
- vasodilator agents
- arterial wave reflection
- endothelial function
- haemodialysis