VASCULAR ENDOTHELIAL-CELL FUNCTION AND CARDIOVASCULAR RISK-FACTORS INPATIENTS WITH CHRONIC-RENAL-FAILURE

Cardiovascular risk factors and markers of endothelial cell function w ere studied in nondiabetic patients with mild to moderate chronic rena l failure. The transcapillary escape rate of albumin and the plasma co ncentrations of von Willebrand factor, fibrinogen, and plasma lipids w ere measured in 29 nondiabetic patients (GFR of 25 (11-44) mL/min x 1. 73 m(2) (median and range)) and 14 normal subjects. The proportion of smokers was similar between the groups. In the patients, the plasma co ncentration of von Willebrand factor was elevated by 61% (1.27 +/- 0.4 4 versus 0.79 +/- 0.28 U/mL; P < 0.01) (mean +/- SD) and that of fibri nogen was elevated by 72% (10.18 +/- 4.14 versus 5.92 +/- 2.01 mu mol/ L; P < 0.01). The plasma concentrations of lipoproteins showed an athe rogenic pattern in the patients with increased levels of very low-dens ity lipoprotein cholesterol (0.57 +/- 0.31 versus 0.33 +/- 0.13 mmol/L ; P < 0.01) and triglycerides(1,26 +/- 0.25 versus 0.71 +/- 0.28 mmol/ L; P < 0.01), but a decreased level of high-density lipoprotein choles terol (1.23 +/- 0.33 versus 1.46 +/- 0.35 mmol/L; P < 0.05). Total cho lesterol and low-density lipoprotein cholesterol were similar in the g roups. The observed differences were further aggravated among smoking patients, particularly with respect to von Willebrand factor and trigl ycerides. The transcapillary escape rate of albumin was similar in the patients and the controls and was not correlated to the level of albu minuria. The combination of probable vascular injury and an elevated p lasma concentration of fibrinogen may increase the risk of thrombotic episodes in the patients and, together with dyslipidemia and hypertens ion, may explain the increased cardiovascular morbidity and mortality in chronic nephropathy.