الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cardiovascular complications are the leading cause behind the excess morbidity and mortality observed in ESRD population. The vascular wall in uremia undergoes two major pathological changes being endothelial dysfunction occurring at the intimal level and vascular remodeling occurring in the media.
Endothelial dysfunction is an early predictor of atherosclerosis and in HD patients, is mainly attributed to factors such as disordered lipid metabolism, oxidative stress, inflammation and uremic toxins accumulation. Visfatin is an intracellular enzyme involved in NAD biosynthesis and metabolism. It was then found to be secreted extracellularly mainly from adipose tissue and can be used as a circulating marker to assess endothelial damage.
Vascular calcification is the hallmark of CKD-MBD. Factors related to the disordered bone and mineral metabolism such as raised serum phosphrous, calcium, PTH and FGF-23 act on the vascular smooth muscle cells promoting vascular calcification. Arteriosclerosis will subsequently develop with stiffening of large elastic type arteries like the aorta leading to several hemodynamic disturbances. Aortic PWV is the gold standard method for the assessment of aortic stiffness and basically depends on the velocity of travel of pulse wave across an arterial segment.
Renal transplant recipients could actually gain benefit from the reduction of circulating uremic toxins affecting the vascular wall with a possible improvement in both endothelial dysfunction and arterial stiffness and thus cardiovascular events.
The aim of the study was to identify the relationship between serum visfatin as a marker for endothelial dysfunction and aortic pulse wave velocity as a marker for arterial stiffness in patients with ESRD on maintenance hemodialysis and in renal transplant recipients.
This case controlled study included 30 ESRD patients on maintenance HD, 30 transplant recipients and 25 healthy controls. All patients were subjected to thorough history taking with emphasis on the duration on dialysis, post-transplant duration, antihypertensive and immunosuppressive medications. Patients with age less than eighteen years old, diabetes mellitus, valvular heart disease, irregular heart rhythm, were excluded from our study.
Endothelial function was assessed by measuring the serum level of visfatin by ELISA method. Arterial stiffness was evaluated by measuring the aortic PWV as an index of large artery stiffness and AIx as an index of peripheral stiffness. They were determined non-invasively using Mobil-O-graph device.
Our results showed that plasma visfatin concentrations were significantly higher in HD patients than in transplant recipients and healthy controls. Similarly, the aortic PWV showed the highest values among HD patients when compared to transplant patients and control. The AIx was significantly higher among HD patients when compared to transplant recipients and healthy controls. However, transplant patients had no significant difference in the AIx values as compared to control. Central systolic blood pressure and central pulse pressure were significantly higher in the HD group compared to the other groups.