Altered vascular homeostasis in chronic kidney disease.

Current treatments of chronic kidney disease (CKD) patients frequently result in progressive decline in renal perfusion, leading to the end-stage renal disease. Such renal failures may be a reflection of the progressive nature of renal microvascular disease. The aim of the present study is to elucidate the mechanism of microvascular homeostasis in CKD patients with moderately impaired renal function. We determined biomarkers relevant to vascular homeostasis, such as circulating endothelial cell (CEC), and biomarkers of vascular repair, such as vascular endothelial growth factor (VEGF), angiopoietin-1, tie-2, angiopoietin-2 and VEGF-R2. The present result revealed an enhanced vascular injury which was reflected by increased number of circulating endothelial cells. In addition, a defective vascular repair was also reflected by deficiencies in angiogenic factors such as VEGF, and angiopoietin-1, whereas the anti-angiogenic factors such as angiopoietin-2 and VEGF-R2 were elevated. In conclusion, the activity against vascular injuries increased under the presence of defective ability of vascular repair in CKD with moderately impaired renal function. This finding may explain the present therapeutic failure in treating these CKD patients, and imply that treatment at an earlier stage of CKD should be implemented.