Endothelial dysfunction marker von Willebrand factor antigen in haemodialysis patients: associations with pre-dialysis blood pressure and the acute phase response

Background, Increased plasma soluble von Willebrand factor antigen (VWF:Ag) level, a marker of vascular endothelial cell dysfunction, is a strong pred ictor of atherosclerotic cardiovascular disease (CVD) in the general popula tion. We studied cross-sectional associations between vWF:Ag level, prevale nce of CVD, and related factors including pre-dialysis arterial blood press ure (BP) and some markers of inflammation in maintenance haemodialysis (HD) patients. Methods and results. Plasma vWF:Ag level measured by an enzyme-linked immun osorbent assay (ELISA) was higher in 110 HD patients than in 20 controls. O n bivariate regression analysis, vWF:Ag level was directly associated with the presence of CVD, age, fibrinogen and the use of enoxaparin (vs unfracti onated heparin) during HD procedures, and inversely with albumin and pre-di alysis BP. The patients with prevalent CVD were older, had higher vWF:Ag, w hite blood cell and platelet counts, fibrinogen and triglycerides, lower al bumin levels, and were less frequently on combination antihypertensive ther apy. Multivariable analyses identified low pre-dialysis BP. hypoalbuminaemi a and hyperfibrinogenaemia (in descending order of significance) as indepen dent predictors of high vWF:Ag level. There were no associations between VW F : Ag levels and gender. ABO blood type, smoking, body mass index. renal f ailure cause, duration of HD therapy, K-t/V, normalized protein catabolic r ate, dialysate buffers, dialysers, viral hepatitis, erythropoietin treatmen t, specific antihypertensive drugs, haemoglobin, white blood cell and plate let counts, liver enzymes. phosphorous, total cholesterol, and triglyceride s. Conclusion. Elevated plasma levels of endothelial dysfunction marker vWF:Ag in maintenance HD patients are associated with established cardiovascular mortality risk factors such as low pre-dialysis blood pressure and the acti vated acute phase response.