الفهرس 
Chronic kidney diseaseOnly 14 pages are availabe for public view
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Abstract
Endothelial dysfunction (ED) is common in patients with moderate to advanced chronic kidney disease (CKD). Recently, visfatin, a protein with insulin-mimetic properties., was shown to be associated with sVCAM-1. Thus, we hypothesised t^aTvis fati n may be a marker of ED in CK.D. F.ndothelial dysfunction represents an obligatory, prodromal phase in the atherosclerosis process. Initially identified and thoroughly investigated in bench experiments, cndothclial dysfunction has now progressed to a full-fledged outcome measure in clinical studies [JJ. Fndothelial function may be tested by two approaches [2]. The first is functional in nature and is based on the forearm haemodynamic response to acetylcholine (a pharmacological stimulus impinging upon the enzyme NO synthase) or to ischaemia [flow-mediated vasodilatation-(FMD) a physiological stimulus to the same enzyme]. The second approach rests on the measurement ofthe plasma concentration of specific biomarkers, i.e. a series of compounds, synthesized within the endothelium and that are released into the systemic circulation when cndothclial integrity is hampered by noxious factors. The intercellular (1CAM) and vascular (VCAM) adhesion molecules, cndothclial selectin (E-Selectin)and von Willebrand Factor (vWF) are currently held as the most reliable biomarkers of eiulolhelial dysfunction/damage. The two approaches look at different aspects of endotliHial function and therefore haemodynamic and biomarker-based tests provide complementary rather than overlapping information on I’ndothelial integrity. Haemodynamic studies appear of particular value in clinical research, because altered endothelium-dependent vaso-regulalory control predicts cardiovascular complications in a variety ofclinical settings. Endothelial function testing is accepted as a valid surrogate endpoint in studies of cardiovascular prevention in children adolescents. Chronic renal insufficiency is recognized as a clinical situation posing major risks to cndotheliiti integrity [3], However, there is still a paucity of haemodynamic studies of endotheital function in patients with chronic kidney disease (CK.D).