The effect of hemodialysis and ultrafiltration on endothel dysfuncti̇on in chroni̇c hemodialysis patients

Cardiovascular diseases are the most frequent mortality cause in hemodialysis patients. Atherosclerosis is the main cause which leads to ischaemic cardiovasculer diseases. Vascular endothelium is the crucial organ in vascular homeostasis which shows vasodilator, antiadhesive, antiinflammatory, anticoagulant features by means of mediators that it excretes. Endothelial dysfunction is an important early event in the pathogenesis of atherosclerosis contributing to plaque initiation andprogression (1-4,11,12,54-60). Recently, measurement of endothelium dependent vasodilatation (flow mediated dilatation) and endothelium independent vasodilatation of the brachial artery has been proposed as a method to noninvasively asses vascular endothelial function and smooth muscle function, respectively (5,50,51). In hemodialysis patients early diagnosis and treatment is extremely important since cardiovascular diseases are the cause of serious mortalities and morbidities. İn this study we have targeted to evaluate the effects of base, HD+UF, isolated HD and isolated UF processes on endothelial function as a noninvasive method. The study has included twenty patients who had been followed 2002-2004 in Celal Bayar University Hospital, Division of Internal Medicine , Nephrology Unit. Brachial artery reactivity evaluated by using 7,5 MHz linear array transducer (Siemens Sonoline Electra) high-resolution dopper ultrasound. A five minute ischaemic whit 200 mmHg pressure was applied by using Erka sfigmomanometer. The measurements have been redone before and after ischaemia . The measurements have been taken from either right ar mor or without fistula. The evaluation for each patients has been redone totaly four times as in intradialytic period (basal) , and after four hours from dialysis treatment in mid–week, after isolate HD, HD+UF and isolate UF. During the measurements the patients have not used any vasoactive agents. Eating ,smoking and drinking containing cafein have been ceased at least twelve hours before the measurements. By using same room (20-25 degrees centigrade), same dialyzer heat and concentration (Na=140mmol/l, K=2 mmol/l, Mg=0,5 mmol/l , bicarbonate=34 mmol/l) and 1,4 m2dialyzer with full synthetic (polisulfan) membranes, the same condition and blood flow (250 ml/min) have been provided for all the patients in hemodialysis sessions. All the patients have been taken in hemodialysis sessions three times in a week. As a result, when flow-mediated dilation data after four transactions were compared with each other, statistically significant diversity has been determined (p=0.003). In comparison to determine the groups that cause diversity, statistically significant diversity has been determined between flow-mediated dilatation data after HD+UF applying and basal flow-mediated dilatation data and isolated UF data. This shows and emphasizes its importance that the volume control with effective HD+UF maket he endothelial dysfunction much beter compared to isolated HD and isolated UF.