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      Visfatin versus Flow-Mediated Dilatation as a Marker of Endothelial Dysfunction in Pediatric Renal Transplant Recipients

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          Abstract

          BACKGROUND:

          Renal transplantation (RTx) is the treatment of choice for paediatric end-stage renal disease (ESRD). A major cause of morbidity and mortality after RTx is cardiovascular disease. Independent predictors of cardiovascular events were shown to constitute an endothelial dysfunction (ED). This study aims to evaluate Visfatin serum level in comparison to brachial artery flow-mediated dilatation (FMD) as a marker of endothelial dysfunction in paediatric RTx recipients.

          METHODS:

          Visfatin serum level has been evaluated in 30 patients on regular hemodialysis (HD), 36 patients post-RTx and 30 controls as a measure for ED, and has been compared to brachial artery FMD.

          RESULTS:

          Visfatin level in transplant recipients was significantly lower than the hemodialysis group as well as FMD was better in transplant recipients. In spite of marked improvement of FMD and marked reduction of visfatin in post-RTx no direct statistical correlation was found between serum Visfatin level and flow-mediated dilatation.

          CONCLUSION:

          Pediatric RTx recipients show lower serum Visfatin level and better FMD than those on regular hemodialysis, reflecting less endothelial dysfunction (ED) and less cardiovascular risk. FMD in kidney transplant recipients tends to be less than normal subjects while visfatin level of the same group is similar to controls. Pediatric RTx appears to have a positive impact on the growth development of children with ESRD.

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          Visfatin: a protein secreted by visceral fat that mimics the effects of insulin.

          Atsunori Fukuhara, Morihiro Matsuda, Masako Nishizawa … (2005)
          Fat tissue produces a variety of secreted proteins (adipocytokines) with important roles in metabolism. We isolated a newly identified adipocytokine, visfatin, that is highly enriched in the visceral fat of both humans and mice and whose expression level in plasma increases during the development of obesity. Visfatin corresponds to a protein identified previously as pre-B cell colony-enhancing factor (PBEF), a 52-kilodalton cytokine expressed in lymphocytes. Visfatin exerted insulin-mimetic effects in cultured cells and lowered plasma glucose levels in mice. Mice heterozygous for a targeted mutation in the visfatin gene had modestly higher levels of plasma glucose relative to wild-type littermates. Surprisingly, visfatin binds to and activates the insulin receptor. Further study of visfatin's physiological role may lead to new insights into glucose homeostasis and/or new therapies for metabolic disorders such as diabetes.
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            Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999.

            Robert N Foley, Anne M Murray, Shuling Li … (2005)
            Knowledge of the excess risk posed by specific cardiovascular syndromes could help in the development of strategies to reduce premature mortality among patients with chronic kidney disease (CKD). The rates of atherosclerotic vascular disease, congestive heart failure, renal replacement therapy, and death were compared in a 5% sample of the United States Medicare population in 1998 and 1999 (n = 1,091,201). Patients were divided into the following groups: 1, no diabetes, no CKD (79.7%); 2, diabetes, no CKD (16.5%); 3, CKD, no diabetes (2.2%); and 4, both CKD and diabetes (1.6%). During the 2 yr of follow-up, the rates (per 100 patient-years) in the four groups were as follows: atherosclerotic vascular disease, 14.1, 25.3, 35.7, and 49.1; congestive heart failure, 8.6, 18.5, 30.7, and 52.3; renal replacement therapy, 0.04, 0.2, 1.6, and 3.4; and death, 5.5, 8.1, 17.7, and 19.9, respectively (P < 0.0001). With use of Cox regression, the corresponding adjusted hazards ratios were as follows: atherosclerotic vascular disease, 1, 1.30, 1.16, and 1.41 (P < 0.0001); congestive heart failure, 1, 1.44, 1.28, and 1.79 (P < 0.0001); renal replacement therapy, 1, 2.52, 23.1, and 38.9 (P < 0.0001); and death, 1, 1.21, 1.38, and 1.56 (P < 0.0001). On a relative basis, patients with CKD were at a much greater risk for the least frequent study outcome, renal replacement therapy. On an absolute basis, however, the high death rates of patients with CKD may reflect accelerated rates of atherosclerotic vascular disease and congestive heart failure.
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              Fundamentals of endothelial function for the clinical cardiologist.

              Subodh Verma, Trevor P. Anderson (2002)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Access Maced J Med Sci
                Journal ID (iso-abbrev): Open Access Maced J Med Sci
                Title: Open Access Macedonian Journal of Medical Sciences
                Publisher: ID Design 2012/DOOEL Skopje (Republic of Macedonia )
                ISSN (Electronic): 1857-9655
                Publication date Collection: 15 April 2017
                Publication date (Electronic): 13 April 2017
                Volume: 5
                Issue: 2
                Pages: 222-227
                Affiliations
                [1 ] Department of Pediatrics, Center of Pediatric Nephrology and Transplantation (CPNT), Cairo University, Cairo, Egypt
                [2 ] EGORD, Egyptian Group of Orphan Renal Diseases, Cairo, Egypt
                [3 ] Department of Pediatrics, National Research Centre, Cairo, Egypt
                [4 ] Department of Clinical Pathology, National Research Centre, Cairo, Egypt
                Author notes
                [* ] Correspondence: Safaa M Abelrahman, Department of pediatrics, Cairo University, Cairo, Egypt, 82 Elmanial Street, Cairo 11511, Egypt. E-mail: safaa.mohamed5@ 123456gmail.com
                Article
                Publisher ID: OAMJMS-5-222
                DOI: 10.3889/oamjms.2017.032
                PMC ID: 5420778
                SO-VID: 73ccd83b-b7a1-46cc-9cb5-e2950f75b256
                Copyright © Copyright: © 2017 Fatina Fadel, Hafez M. Bazraa, Safaa M. Abdelrahman, Mohamed Gamal Shouman, Marwa Khaled Sayed, Doaa Mohamed Salah, Aliaa Ahmed Wahby, Heba F. Elgebaly.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

                History
                Date received : 19 November 2016
                Date revision received : 13 March 2017
                Date accepted : 14 March 2017
                Categories
                Subject: Clinical Science

                Keywords: end stage renal disease (esrd),children,endothelial dysfunction (ed),flow- mediated dilatation (fmd),renal transplantation (rtx),visfatin
                Data availability:
                Keywords: end stage renal disease (esrd), children, endothelial dysfunction (ed), flow- mediated dilatation (fmd), renal transplantation (rtx), visfatin

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