Nephrol Dial Transplant (1990) 5: 418-422 © 1990 European Dialysis and Transplant Association-European Renal Association
Nephrology Dialysis Transplantation
Endothelin in Renal Failure A. N. Warrens1, M. J. D. Cassidy1, K. Takahashi2, M. A. Ghatei2 and S. R. Bloom2 'Renal and 2Endocrine Units, Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK
Abstract. Endothelin is a 21 -residue peptide vasoconstrictor produced by endothelium. Using a radioimmunoassay, endothelin values were measured in four groups of individuals: normal controls (0.54+ 0.12 pmol/1, « = 20); undialysed patients with chronic renal failure (CRF) (0.82 + 0.13 pmol/1, « = 38); chronic renal failure patients on continuous ambulatory peritoneal dialysis (CAPD) (2.81 ±0.63 pmol/1, « = 20); and patients with CRF on haemodialysis (HD) (4.52+1.21 pmol/1, n=14). The endothelin values were significantly greater in undialysed patients with CRF when compared with controls (P< 0.001) and significantly greater in both dialysis groups when compared with controls and the undialysed CRF group (/M 0.001). The difference between the two dialysis groups was not significant (/>=0.07). There was no correlation between endothelin and serum creatinine, mean arterial pressure, presence of chronic hypertension and/or diabetes, use of calcium-channel blockers and/or ACE inhibitors, or primary renal diagnostic category. A single haemodialysis session had no significant effect on endothelin values in the ten patients in whom this was assessed. Fast protein liquid chromatography (FPLC) appeared to confirm that the molecular species found in chronic renal failure were the same as those found in diabetic patients. Key words: Continuous ambulatory peritoneal dialysis; Endothelin; Haemodialysis; Renal failure; Uraemia
Correspondence and offprint requests to: Dr A. N. Warrens, Renal Unit,
Hammersmith Hospital, Du Cane Road, London W120HS.
Introduction In recent years it has been observed that the endothelium secretes factors that can affect vascular smooth muscle tone. Endothelium-dependent or enhanced vasoconstriction has been observed in response to noradrenaline , thrombin , hypoxia [1,3], increased transmural pressure , and mechanical stretch . A 21-residue vasoconstrictor peptide derived from endothelium and given the name endothelin has now been described in porcine  and human  material. The most potent vasoconstrictor peptide yet isolated , endothelin has been found to be present in elevated concentrations in patients on haemodialysis [8,9]. The aim of this study was to elucidate further the effects of chronic renal impairment on plasma endothelin values in undialysed patients and in patients on peritoneal and haemodialysis.
Patients and Methods Patients Blood was taken from consecutive patients with impaired or absent renal function who were seen in one of three settings: a general nephrology out-patient clinic (CRF) (38 patients, group 1); continuous ambulatory peritoneal dialysis (CAPD) clinic (20 patients, group 2); and the hospital haemodialysis unit (14 patients, group 3). These groups were similar in age and sex distribution. Mean arterial blood pressure was significantly lower in the undialysed CRF group (P