LOW NITRIC-OXIDE PRODUCTION IN PATIENTS WITH CHRONIC-RENAL-FAILURE

Background: Rats with chronic renal failure have a low nitric oxide (N O) production and a diminished NO excretion. The supplementation of L- arginine has an inhibitory effect on the progression of renal insuffic iency. Methods: The present study was designed to determine whether ch ronic renal failure patients have a low NO production. Plasma and urin e nitrate (NO3) and nitrite (NO2), stable metabolites of NO, were meas ured in 83 consecutive patients with chronic renal failure. The 83 chr onic renal failure patients were divided into three groups: group 1, m ild renal failure (creatinine clearance >60 ml/min/1.73 m(2)); group 2 , moderate renal failure (creatinine clearance >30 <60 ml/min/1.73 m(2 )), and group 3, severe renal failure (creatinine clearance <30 ml/min /1.73 m(2)). Thirty-three healthy volunteers served as controls. Resul ts: The daily urinary NO excretion was significantly lower in patients with moderate and severe renal failure as compared with those with mi ld renal failure and normal controls. The lowest values were found in the severe renal failure group. When the 24-hour urinary NO excretion or NO per milligram creatinine and the NO clearance were correlated wi th the renal function in all patients as a group, these parameters wer e directly correlated with the creatinine clearance and inversely corr elated with the serum creatinine level. The plasma NO concentration wa s not different between the three chronic renal failure groups, but hi gher than in the controls. Plasma NO in renal failure patients was not correlated with the creatinine clearance or serum creatinine levels. Conclusions: Chronic renal failure is a state of NO deficiency. Treatm ent strategies to increase NO production (L-arginine supplementation o r other NO compounds) may prove to be useful in maintaining the renal function and slow the progression of renal disease.