지속적 혈액투석환자에서 Desferrioxamine 투여 후의 혈장 Endothelin 농도 변화 = Effect of Desferrioxamine on Plasma Endothelin Concentration in Maintenance Hemodialysis Patients

다국어 초록 (Multilingual Abstract)

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다국어 초록 (Multilingual Abstract)

Objectives: It has been reported that the risk of oxygen radical injury is increased in chronic renal failure due to the decreased endogenous serum antioxidants. Especially, the C5a induced by membrane bioincompatibility can stimulates neutrophils to release of oxygen free radicals, resulting in endothelial cell injury. However, Desferrioxamine(DFO) act as an iron chelator, which blocks iron-catalyzed Haber-Weiss reaction and inhibits release of oxygen free radicals from activated neutrophils. It is also reported that endothelin(ET) can be released from endothelial cells in response to vascular damage such as atherosclerosis. Therefore, we administered DFO, into maintenance hemodialyein patients. Then we examined the possibility of oxygen radical injury during interdialytic period and its relation with the plasma ET concentration. Methods: During the last 1-2 hours of hemodialysis, DFO(40mg/kg in 5% D/W 200cc) was infused intravenously into 13 patients(DFO group), and placebo(5% D/W 200cc only) was infused with same manner into 9 patients(Placebo group). We sampled blood for measurement of plasma ET concentration just before the initiation of hemodialysis on the day of infusion, on the 2nd-3rd day and on the 7th day after infusion. Also, we examined 26 non-diabetic patients with normal renal function as a norma1 control. Results: The mean plasma ET concentration in total hemodialysis patients is higher (5.08±3.09pg/ ml) than in normal control (2.58±1.08pg/ml, p<0.01). There was no statistical difference between two hemodialysis groups in plasma ET concentration measured before infusion (5.56±3.50pg/ml in DFO group, 4.38±2.40 pg/ml in placeb group). In DFO group, plasma ET concentration decreased significantly on the 2nd-3rd day (3,49±2.08pg/ml, p<0.01), but increased significantly on the 7th day (5.62± 2.95pg/ml, p<0.05), In contrast, there were no significant changes in plasma ET concentration in placebo group. There was no significant difference in the decrement of plasma ET between the cases of transferrin saturation below and above 60% and there was no relation between the plasma ET decrement and transferrin saturation or serum ferritin in DFO group. Conclusion: The decrease of plasma ET concentration after DFO infusion might be the result of diminished endothelial cell injury from oxygen free radicals. Therefore, we believe that the oxygen radical injury can occur during not only the hemodialysis but also the interdialytic period. Also these results suggest that the oxidant damage of endothelial cell may be one of the causes of elevated ET concentration in chronic renal failure, However, we could not confirm in this study whether the obtained results were caused by the chronic effects of membrane bioincompatibility or by the decreased endogenous serum antioxidants.