Korean Journal of Nephrology 1996;15(4):547-557.

혈액투석 환자에서 혈중 Endothelin-1 (ET-1)및 Lipoprotein(a) ( Lip (a) ) 농도에 동정맥루 폐쇄의 상관 관계에 관한 연구

강걷희 , 윤견일

Abstract

Reliable vascular access has been described as the Achilles heel of modern hemodialysis (HD) patients. In spite of the improved technology in vascular surgery, vascular access occlusion (VAO) by throm- bosis and stenosis has been a constant problem, accounting for 10-40% of all hospital admissions of dialysis patients. Runoff vein stenosis due to vascular smooth muscle (neointimal') hyperplasia has been found to be one of the most common pathologic findings in cases with anatomic lesions of VAO. ET-1 is a naturally occurring vasoactive substance which has an intense mitogenic effect on cultured vascular smooth muscle cells and Lp(a) is known to be an independent predictor of coronary risk and coronary bypass stenosis. However, the clinical significance of the increased ET-1 and Lp(a) in relation to VAO is uncertain in HD patients. The present study was undertaken to evaluate the clinical significance of Lp(a) and ET-1 as a possible risk factor for VAO in 50 HD patients (male:'female 29:21, mean age 48 years, mean HD duration 47 months). The frequency of VAO in entire subjects was 0.47±1.03 episodes/patient-year. The median value of Lp(a) was 10.8mg/dl (1.9-87.6mg/dl) and the median value of ET-1 was 8,3 pg/ml (3.2-29.3 pg/ml). Fourteen patients (28% of subjects) were found to have at least one episode of VAO. There was no statistically significant difference in sex, age, blood pressure, % of patients receiving rHuEpo between VAO and non-VAO group. Biochemical parameters including Lp(a) & ET-1 were not different between VAO and non-VAO group. Six out of 50 patients (12%) had increased levels of ET-1 above mean ±2SD. In those patients with increased ET-1, the frequency of VAO was higher (1.83±1.65 vs. 0.38±0.54 episodes/patient-year, p<0.05). The median survival of vascular access for this high ET-1 group was 14.5 months, which was signi- ficantly lower compared to 77.8 months in patients whose ET-1 level was below 16pg/mL However, there was no significant difference in vascular access survival according to the level of Lp(a), In conclusion, the level of ET-1 can affect the event free vascular access survival in HD patients, while the Lp(a) level seems to be unrelated to the VAO in our Korean HD patients. Further prospective studies are necessary to know the exact clinical significance of increased ET-1 and Lp(a) in the occurrence of access occlusion in maintenance HD patients.