The Dynamics and Interaction of Endothelium State and Immune Status Variations in Program Hemodialysis Patients against the Background of Atorvastatin Therapy
The aim of the investigation was to study the interaction of endothelium state and immune status variations in program hemodialysis (PHD) patients against the background of atorvastatin therapy.
Materials and Methods. 54 patients included in the study were divided into two groups in a random manner. The main group patients (n=28) received atorvastatin, 20 mg a day, for 30 days against the background of PHD, the main patients (n=26) had PHD alone. Endothelin level (1–21) and Willebrand factor activity were determined by enzyme immunoassay, the content of active nitric oxide metabolites was estimated spectrophotometrically. The immune status indices (CD3, CD4, CD8, CD16, CD19, CD56) were studied by monoparametric analysis using monoclonal antibody technique. The content of interleukins (IL-6, IL-10, IL-1β) and tumor necrosis factor α (TNF-α) were investigated using enzyme immunoassay.
Results. PHD patients within the observation period (30 days) were found to have the following changes: high concentration of nitric oxide and endothelin (1-21), reduced Willebrand factor activity; the decrease of relative number of T-helpers and the increased number of cytotoxic Т-lymphocytes, as well as the increased IL-10 level and reduced TNF-α level in relation to the initial values. Atorvastatin administration for 30 days does not have any significant effect on endothelium condition, but reduces total lymphocyte count and immunoregulatory index, as well as proinflammatory cytokine IL-6 level in PHD patients.
The main patients in the observation period were found to have the interaction of the changed values of endothelium state (nitric oxide level) with the levels of IL-6 and IL-10, TNF-α, as well as Willebrand factor activity — with relative number of T-helpers and immunoregulatory index.
The patients with atorvastatin therapy were recorded to have nothing but the interaction of the Willebrand factor activity changes with IL-6 content.
Conclusion. Due to the necessity of long-term administration of statin preparations in program hemodialysis patients, it is recommended to control the changes of endothelium state and immune status values in the course of the treatment.
- Rtisheva O.V., Kalev O.A., Akhmatov V.Yu. Struktura prichin letal'nykh iskhodov u bol'nykh, nakhodyashchikhsya na programmnom gemodialize. Klinicheskaya nefrologiya [The structure of causes of lethal outcomes in program hemodialysis patients]. Klinicheskaya nefrologiya — Clinical Nephrology 2011; 1: 43–45.
- Susekov A.V. Giperlipidemiya — sovremennoe sostoyanie problemy i metody ee medikamentoznoy korrektsii [Hyperlipidemia — present problem state and the methods of its medical correction]. Rus Med Z — Russian Medical Journal 2003; 5: 267–270.
- Fesenko E.V., Proshchaev K.I., Polyakov V.I. Pleyotropnye effekty statinov i ikh rol’ v preodolenii problemy polimorbidnosti [Pleiotropic action of statins and their role in overcoming the problem of multimorbidity]. Covremennye problemy nauki i obrazovaniya — Present problems of Science and Education 2012; 2: 1–8.
- Parkhomenko A.N., Lutay Ya.M. Rannee primenenie simvastatina u bol’nykh s ostrym koronarnym sindromom: vliyanie na dinamiku markerov vospaleniya i rezul’taty klinicheskikh nablyudeniy [Early simvastatin administration in patients with acute coronary syndrome: the effect on inflammation markers dynamics and the results of clinical observations]. Ukranskiy kardiologichniy zhurnal — Ukrainian Cardiological Journal 2005; 3: 36–45.
- Han S.H., Kang E.W., Yoon S.J., et al. Combined vascular effects of HMG-CoA reductase inhibitor and angiotensin receptor blocker in non-diabetic patients undergoing peritoneal dialysis. Nephrol Dial Transplant 2011; 26(11): 3722–3728.
- Kishimoto N., Hayashi T., Sakuma I., et al. A hydroxymethylglutaryl coenzyme A reductase inhibitor improves endothelial function within 7 days in patients with chronic hemodialysis. Int J Cardiol 2010; 145(1): 21–26.
- Karpov Yu.A., Sorokin E.V. Ateroskleroz i faktory vospaleniya: nelipidnye mekhanizmy deystviya statinov [Atherosclerosis and inflammatory factors: non-lipid mechanisms of statins]. Rus Med Z — Russian Medical Journal 2001; 10: 418–421.
- Pertosa G., Grandaliano G., Simone S. et al. Inflammation and carnitine in hemodialysis patients. J Ren Nutr 2005; 15(1): 8–12.
- Goicoechea M., Quiroga B., Garca de Vinuesa S., et al. Intraindividual interleukin-6 variations on the cardiovascular prognosis of patients with chronic renal disease. Ren Fail 2012; 34(8): 1002–1009.
- Kessler M., Kano B., Pedrini L.A., et al. Evropeyskie rekomendatsii po optimal’noy praktike gemodializa. Chast’ 1 [European recommendations for optimal hemodialysis. Part 1]. Oxford (UK): Oxford University Press; 2005; 112 p.
- Jourde-Chiche N., Dou L., Cerini C., et al. Vascular incompetence in dialysis patients-protein-bound uremic toxins and endothelial dysfunction. Semin Dial 2011; 24(3): 327–337.
- Malyszko J., Malyszko J.S., Hryszko T., et al. Simvastatin and markers of endothelial function in patients undergoing continuous ambulatory peritoneal dialysis. Int J Tissue React 2002; 24(3): 111–115.
- Korybalska K., Kawka E., Breborowicz A., Witowski J. Atorvastatin does not impair endothelial cell wound healing in an in vitro model of vascular injury. J Physiol Pharmacol 2012; 63(4): 389–395.
- Meier P., Meier R., Blanc E. Influence of CD4+/CD25+ regulatory T cells on atherogenesis in patients with end-stage kidney disease. Expert Rev Cardiovasc Ther 2008; 6(7): 987–997.
- Atamanova T.Yu. Vliyanie dlitel’noy terapii statinami na immunnuyu sistemu bol’nykh ishemicheskoy bolezn’yu serdtsa. Avtoref. dis. ... kand. med. nauk [The effect of a long-term statin therapy on immune system of ischemic patients: Abstract for Dissertation for the degree of Candidate of Medical Science]. Chelyabinsk; 2006.
