Coronary and Systemic Vasodilator Responsiveness of Patients Receiving Conventional Intermittent or Nocturnal Hemodialysis-Reference-Cited by-同舟云学术

Coronary and Systemic Vasodilator Responsiveness of Patients Receiving Conventional Intermittent or Nocturnal Hemodialysis

Published:2024-09 Issue:9 Volume:81 Page:1996-2005
ISSN:0194-911X
Container-title:Hypertension
language:en
Short-container-title:Hypertension

Author:

Overgaard Christopher B.¹²³⁴,Chan William¹²³⁴⁵^ORCID,Chowdhary Saqib¹²³⁴⁶^ORCID,Zur Rebecca L.²³⁴⁷^ORCID,Wainstein Rodrigo¹²³⁴⁸^ORCID,Džavík Vladimír²³⁴^ORCID,Chan Christopher T.²⁴^ORCID,Floras John S.¹²³⁴^ORCID

Affiliation:

1. Harold and Esther Mecklinger Family and the Posluns Family Cardiac Catheterization Research Laboratory, Mount Sinai Hospital, Toronto, ON, Canada (C.B.O., W.C., S.C., R.W., J.S.F.).

2. University Health Network and Sinai Health Department of Medicine, Division of Cardiology (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.).

3. Peter Munk Cardiac Centre, University Health Network (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., J.S.F.).

4. Department of Medicine (C.B.O., W.C., S.C., R.L.Z., R.W., V.D., C.T.C., J.S.F.), University of Toronto, ON, Canada.

5. Western Health, St. Albans, VIC, Australia (W.C.).

6. Manchester University NHS Foundation Trust, United Kingdom (S.C.).

7. Department of Psychiatry (R.L.Z.), University of Toronto, ON, Canada.

8. Hospital de Clínicas de Porto Alegre, Federal University do Rio Grande do Sul, Brazil (R.W.).

Abstract

BACKGROUND: Nocturnal hemodialysis (nHD) restores the attenuated brachial artery vasodilator responsiveness of patients receiving conventional intermittent hemodialysis (iHD). Its impact on coronary vasodilatation is unknown. METHODS: We evaluated 25 patients on hemodialysis who fulfilled transplant criteria: 15 on iHD (4-hour sessions, 3 d/wk) and 10 on nHD (≈40 h/wk over 8–10-hour sessions) plus 6 control participants. Following diagnostic angiography, left anterior descending (LAD) coronary flow reserve and mean luminal diameter were quantified at baseline and during sequential intracoronary administration of adenosine (infusion and bolus), nitroglycerin (bolus), acetylcholine (infusion), acetylcholine coinfused with vitamin C, and, finally, sublingual nitroglycerin. RESULTS: Coronary flow reserve in those receiving nHD was augmented relative to iHD (3.28±0.26 versus 2.17±0.12 [mean±SEM]; P <0.03) but attenuated, relative to controls (4.80±0.63; P =0.011). Luminal dilatations induced by intracoronary adenosine and nitroglycerin were similar in nHD and controls but blunted in the iHD cohort ( P <0.05 versus both). ACh elicited vasodilatation in controls but constriction in both dialysis groups (both P <0.05, versus control); vitamin C coinfusion had no effect. Sublingual nitroglycerin increased mid-left anterior descending diameter and reduced mean arterial pressure in controls (+15.2±2.68%; −16.00±1.60%) and in nHD recipients (+14.78±5.46%; −15.82±1.32%); iHD responses were markedly attenuated (+1.9±0.86%; −5.89±1.41%; P <0.05, all comparisons). CONCLUSIONS: Coronary and systemic vasodilator responsiveness to both adenosine and nitroglycerin is augmented in patients receiving nHD relative to those receiving iHD, whereas vasoconstrictor responsiveness to acetylcholine does not differ. By improving coronary conduit and microvascular function, nHD may reduce the cardiovascular risk of patients on dialysis.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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