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Peritoneal dialysis impairs nitric oxide homeostasis and may predispose infants with low systolic blood pressure to cerebral ischemia

Carlström, Mattias; Cananau, Carmen; Checa, Antonio; Wide, Katarina; Sartz, Lisa LU ; Svensson, Anders; Wheelock, Craig E.; Westphal, Susanne; Békássy, Zivile LU and Bárány, Peter, et al. (2016) In Nitric Oxide - Biology and Chemistry 58. p.1-9
Abstract

Background & purpose Infants on chronic peritoneal dialysis (PD) have an increased risk of developing neurological morbidities; however, the underlying biological mechanisms are poorly understood. In this clinical study, we investigated whether PD-mediated impairment of nitric oxide (NO) bioavailability and signaling, in patients with persistently low systolic blood pressure (SBP), can explain the occurrence of cerebral ischemia. Methods & results Repeated blood pressure measurements, serial neuroimaging studies, and investigations of systemic nitrate and nitrite levels, as well as NO signaling, were performed in ten pediatric patients on PD. We consistently observed the loss of both inorganic nitrate (-17 ± 3%, P < 0.05) and... (More)

Background & purpose Infants on chronic peritoneal dialysis (PD) have an increased risk of developing neurological morbidities; however, the underlying biological mechanisms are poorly understood. In this clinical study, we investigated whether PD-mediated impairment of nitric oxide (NO) bioavailability and signaling, in patients with persistently low systolic blood pressure (SBP), can explain the occurrence of cerebral ischemia. Methods & results Repeated blood pressure measurements, serial neuroimaging studies, and investigations of systemic nitrate and nitrite levels, as well as NO signaling, were performed in ten pediatric patients on PD. We consistently observed the loss of both inorganic nitrate (-17 ± 3%, P < 0.05) and nitrite (-34 ± 4%, P < 0.05) during PD, which may result in impairment of the nitrate-nitrite-NO pathway. Indeed, PD was associated with significant reduction of cyclic guanosine monophosphate levels (-59.4 ± 15%, P < 0.05). This reduction in NO signaling was partly prevented by using a commercially available PD solution supplemented with l-arginine. Although PD compromised nitrate-nitrite-NO signaling in all cases, only infants with persistently low SBP developed ischemic cerebral complications. Conclusions Our data suggests that PD impairs NO homeostasis and predisposes infants with persistently low SBP to cerebral ischemia. These findings improve current understanding of the pathogenesis of infantile cerebral ischemia induced by PD and may lead to the new treatment strategies to reduce neurological morbidities.

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published
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keywords
Blood pressure, Cerebral ischemia, cGMP, Chronic kidney disease (CKD), Dialysis, Nitrate, Nitric oxide, Nitric oxide synthase (NOS), Nitrite
in
Nitric Oxide - Biology and Chemistry
volume
58
pages
9 pages
publisher
Elsevier
external identifiers
  • scopus:84974533494
  • wos:000380628400001
ISSN
1089-8603
DOI
10.1016/j.niox.2016.05.005
language
English
LU publication?
yes
id
f244b6c8-fc6b-49b4-9974-7e5a75a0ec66
date added to LUP
2016-11-29 16:01:25
date last changed
2017-06-02 08:23:47
@article{f244b6c8-fc6b-49b4-9974-7e5a75a0ec66,
  abstract     = {<p>Background &amp; purpose Infants on chronic peritoneal dialysis (PD) have an increased risk of developing neurological morbidities; however, the underlying biological mechanisms are poorly understood. In this clinical study, we investigated whether PD-mediated impairment of nitric oxide (NO) bioavailability and signaling, in patients with persistently low systolic blood pressure (SBP), can explain the occurrence of cerebral ischemia. Methods &amp; results Repeated blood pressure measurements, serial neuroimaging studies, and investigations of systemic nitrate and nitrite levels, as well as NO signaling, were performed in ten pediatric patients on PD. We consistently observed the loss of both inorganic nitrate (-17 ± 3%, P &lt; 0.05) and nitrite (-34 ± 4%, P &lt; 0.05) during PD, which may result in impairment of the nitrate-nitrite-NO pathway. Indeed, PD was associated with significant reduction of cyclic guanosine monophosphate levels (-59.4 ± 15%, P &lt; 0.05). This reduction in NO signaling was partly prevented by using a commercially available PD solution supplemented with l-arginine. Although PD compromised nitrate-nitrite-NO signaling in all cases, only infants with persistently low SBP developed ischemic cerebral complications. Conclusions Our data suggests that PD impairs NO homeostasis and predisposes infants with persistently low SBP to cerebral ischemia. These findings improve current understanding of the pathogenesis of infantile cerebral ischemia induced by PD and may lead to the new treatment strategies to reduce neurological morbidities.</p>},
  author       = {Carlström, Mattias and Cananau, Carmen and Checa, Antonio and Wide, Katarina and Sartz, Lisa and Svensson, Anders and Wheelock, Craig E. and Westphal, Susanne and Békássy, Zivile and Bárány, Peter and Lundberg, Jon O. and Hansson, Sverker and Weitzberg, Eddie and Krmar, Rafael T.},
  issn         = {1089-8603},
  keyword      = {Blood pressure,Cerebral ischemia,cGMP,Chronic kidney disease (CKD),Dialysis,Nitrate,Nitric oxide,Nitric oxide synthase (NOS),Nitrite},
  language     = {eng},
  month        = {08},
  pages        = {1--9},
  publisher    = {Elsevier},
  series       = {Nitric Oxide - Biology and Chemistry},
  title        = {Peritoneal dialysis impairs nitric oxide homeostasis and may predispose infants with low systolic blood pressure to cerebral ischemia},
  url          = {http://dx.doi.org/10.1016/j.niox.2016.05.005},
  volume       = {58},
  year         = {2016},
}