Successful renal transplantation decreases aortic stiffness and increases vascular reactivity in dialysis patients

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Abstract
Background. Patients with end-stage renal disease on dialysis have among the highest cardiovascular event rates documented. Abnormal nitric oxide (NO)-dependent endothelial reactivity and increased arterial stiffness are commonly described in hemodialysis (HD) patients. Measures of aortic stiffness—aortic pulse wave velocity (PWV) and augmentation index (AGI)—have been shown to be powerful predictors of survival on hemodialysis. It is not known how these parameters interfere with successful renal transplantation. Methods. PWV and aortic AGI (difference between the first and second systolic peak on the aortic pressure waveform divided by the pulse wave height) were determined from contour analysis of arterial waveforms recorded by applanation tonometry using a SphygmoCor device in 41 HD patients (20 men; age, 41.8 years) and in a control group of 20 patients with essential hypertension (HTA) (10 men; age, 43.6 years). Twenty of the HD patients (10 men; age, 39.7 years) received live-related renal transplants (RTx) and were restudied (3 months after RTx, normal serum creatinine). NO-dependent and NO-independent vascular reactivity were assessed by changes in AGI after challenges with inhaled salbutamol (SAL) and sublingual nitroglycerin (NTG), respectively. Results. AGI values were significantly lower in RTx patients compared with subjects on hemodialysis (15.9±13.9% vs. 27.9±11.9%, P P P P P P <0.05 for comparison) but similar to the control group of essential HTA patients. Conclusions. Renal transplantation is associated with marked improvements in vascular structure and function to a profile comparable to essential HTA patients.