doiSerbia

Levels of vascular endothelial growth factor during first six months of peritoneal dialysis

Stojimirović Biljana (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Nephrology, Belgrade)
Jovanović Nataša (School of Medicine, Belgrade + Clinical Center of Serbia, Clinic of Nephrology, Belgrade)
Trbojević-Stanković Jasna (School of Medicine, Belgrade + Clinical-Hospital Center “Dr Dragiša Mišović”, Department of Dialysis, Belgrade)
Krstić Slobodan (University of Belgrade, School of Medicine, Belgrade + Clinical Center of Serbia, Clinic for Digestive Diseases, Belgrade)
Nešić Dejan (School of Medicine, Institute of Medical Physiology, Belgrade)
Žunić-Božinovski Snežana (School of Medicine, Institute of Pathophysiology, Belgrade)

Introduction. Chronic peritoneal dialysis (PD) up-regulates vascular endothelial growth factor (VEGF) synthesis and VEGF is found in drained dialysate (dd). Objective. Aims of this prospective study were to evaluate serum (s) and ddVEGF concentration during the first six months of PD, relationships between these concentrations and demographic and biochemical parameters, presence of diabetes, peritonitis, and the use of medications. Methods. The study included 20 patients, with the mean age of 62.9±12.69, 11 of whom were affected by diabetes mellitus. Fasting venous blood samples were taken at the beginning and after six months of PD, in tri-potassium ethylenediaminetetraacetic acid (K3EDTA) vacutainer. Results. After six months of PD, sVEGF concentrations increased significantly, without significant change in ddVEGF. Concentrations of sVEGF at the beginning of chronic PD treatment directly significantly correlated with serum fibrinogen, and after six months with fibrinogen and glycemia. In patients receiving erythropoiesis-stimulating agent (ESA), levels of sVEGF and ddVEGF were lower at baseline, while after six months of PD ddVEGF increased. In patients not receiving ESA, sVEGF increased more prominently, while ddVEGF decreased. The changes were not statistically significant. Patients receiving angiotensinconverting- enzyme inhibitor (ACEi) had sVEGF and ddVEGF levels insignificantly lower than those not using ACEi, however sVEGF significantly increased during six months of PD. After six months of PD, ddVEGF was significantly higher compared to those not using ACEi. Treatment with statins did not significantly influence levels of sVEGF and ddVEGF during the follow-up. Concentrations of sVEGF were continually lower than those of ddVEGF and increased more, while concentrations of ddVEGF were higher in patients using statins. Conclusion. Serum and drained dialysate concentrations of VEGF in PD patients were connected with poorer metabolic profile, while the role of inflammation and treatment agents should be studied further.

Keywords: peritoneal dialysis, VEGF, statins, erythropoietin stimulating agents, angiotensin converting enzyme inhibitors