Plasma stable nitric oxide end products and endothelin-1 states in patients undergoing hemodialysis due to chronic end stage rena disease

In patients with end-stage renal disease [ESRD], it is essential to mandate an active screening for high risk factors of coronary atherosclerosis through periodical clinical examination and determination of the traditional and non traditional risk factors for cardiovascular disease [CVD]. Determination of two novel biochemical atherogenic risk factors: plasma nitric oxide [NO] metabolites [nitrite: NO2 and nitrate: NO3] and endothelin-1 [ET-1] concentrations in patients with end stage renal disease who were undergoing hemodialysis. The present study population was classified into: [i] A healthy reference [control] group which comprised 13 clinically healthy blood donors or patients' relatives and [ii] ESRD group which comprised 19 patients with chronic end stage renal failure [ESRD] who were undergoing intermittent hemodialysis [HD] All patients and controls were subjected for determination of plasma native NO-2/NO-3 concentrations by a colorimetric assay and plasma ET-1 concentrations using an enzyme immunometric immunoassay [EIA]. Plasma total nitrites [NO-2,+NO-3], native nitrites and calculated nitrates [umol/mi] and plasma ET-l [pg/mi] levels were significantly higher in ESRD patients both before and after dialysis sessions than their corresponding levels of healthy controls. Hemodialysis sessions induced non significant increase of NO metabolites [NOx, NO2 and NO3] and ET-1 levels above the predialysis values. However, nitrate: native nitrite ratios in the HD-patients both before and after dialysis [1.7: 1 and 1.5: 1] were significantly lower than the corresponding normal ratio [3.1:1]. Plasma total nitrites comprised 21.2% native nitrites in healthy subjects. The native nitrites fraction increased to 37.0% and 40.0% of the total nitrites in ESRF patients immediately before and after HD sessions, respectively. Patients with ESRD who were undergoing hemodialysis presented significant increase of novel vasoactive CVD risk factors [NO and PT-I] when compared with the corresponding healthy reference values. Although there was a significant correlation between No meyabolites and ET-1, plasma NO metabolites concentrations did not necessarily reflect the hemodynamically active plasma NO component

Diabetic foot syndrome: a relevant growth factor

The role of different growth factors in both micro and macroangiopathic complications of diabetes had not been explored enough. One of the most relevant growth factor in diabetic foot syndrome patients [DFU] is the vascular endothelial growth factor [VEGF]. Some therapeutic trials has been started based on the hypothesis that administration of VEGF will lead to stimulation of angiogenesis and increased collaterals both in peripheral arterial disease [PAD] and coronary artery disease [CAD] specially in inoperable patients. To study plasma VEOF levels in diabetic patients and its relation to PAD in the different subtype of Diabetic foot ulcer whether isehemic, neuropathic or neuroischemic. Sixty nine patients with type 2 diabetes were recruited into this study; 38 had DFU and 31 patients without foot ulceration [diabetic group], together with 24 healthy subjects of matched age and sex as a control group.Ankle brachial pressure was assessed by Doppler ultrasound. The diagnosis of peripheral neuropathy was based on complete neurological assessment of both lower limbs with special stress on pressure perception evaluated by using 10 gram monnfllament [5.07 SW monofilament]. Angiography examination of lower limb vessels was done. Plasma level of VEGF was estimated. Serum VEOF was significantly increased in DFIJ patients and in patients with ischemic ulcers. The increase was more pronounced in latter than the former group. The elevated plasma VEOF levels are unlikely to be explained by other confounding variables such as variability in metabolic control, concomitant retinopathy or increased urinary albumin excretion. Whether the high plasma levels of VEGF could affect clinical outcome or have an impact on response to therapy as it is the case in patients with acute coronary syndrome will definitely merit further studies