接受常规间歇性或夜间血液透析的患者的冠状动脉和全身血管扩张反应。

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

机构信息

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.).

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.).

出版信息

Hypertension. 2024 Sep;81(9):1996-2005. doi: 10.1161/HYPERTENSIONAHA.124.22790. Epub 2024 Jul 23.

DOI:10.1161/HYPERTENSIONAHA.124.22790

PMID:39041205

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]; <0.03) but attenuated, relative to controls (4.80±0.63; =0.011). Luminal dilatations induced by intracoronary adenosine and nitroglycerin were similar in nHD and controls but blunted in the iHD cohort (<0.05 versus both). ACh elicited vasodilatation in controls but constriction in both dialysis groups (both <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%; <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.

摘要

背景

夜间血液透析（nHD）恢复了接受常规间歇性血液透析（iHD）患者减弱的肱动脉血管舒张反应性。但其对冠状动脉舒张的影响尚不清楚。

方法

我们评估了 25 名符合透析移植标准的患者：15 名接受 iHD（4 小时/次，每周 3 次），10 名接受 nHD（每周约 40 小时，8-10 小时/次），外加 6 名对照参与者。在诊断性血管造影后，在基线时和序贯冠状动脉内给予腺苷（输注和推注）、硝酸甘油（推注）、乙酰胆碱（输注）、乙酰胆碱与维生素 C 共同输注以及舌下硝酸甘油后，定量测量左前降支（LAD）的冠状动脉血流储备和平均管腔直径。

结果

与 iHD 相比，接受 nHD 的患者的冠状动脉血流储备增加（3.28±0.26 与 2.17±0.12[平均值±SEM]；<0.03），但与对照组相比减弱（4.80±0.63；=0.011）。nHD 和对照组的冠状动脉内给予腺苷和硝酸甘油引起的管腔扩张相似，但在 iHD 组中减弱（均<0.05，与对照组相比）。ACh 在对照组中引起血管舒张，但在两组透析患者中引起血管收缩（均<0.05，与对照组相比）；维生素 C 共同输注没有影响。舌下硝酸甘油增加了对照组和 nHD 受者的左前降支中段直径和平均动脉压（对照组+15.2±2.68%；-16.00±1.60%）和 nHD 受者+14.78±5.46%；-15.82±1.32%；iHD 的反应明显减弱（+1.9±0.86%；-5.89±1.41%；均<0.05，所有比较）。