A clinical study of serum prostaglandins in ESRD patients

The author performed a study on serum prostaglandins (PG), especially their relation to blood pressure and aortic pulse wave velocity (PWV). A total of 94 end-stage renal disease (ESRD) patients and 27 healthy volunteers (HV) were selected for this study. The ESRD patients were divided into 3 groups as follows; undialysed patients (UD, n=15), maintenance-dialyzed patients (MD, n=74), and anephric patients (AN, n=5). The measured PGs were PGE2, PGF2α, thromboxane (TX) B2, which is a stable metabolite of TXA2, and 6-keto-PGF1α, which is a stable metabolite of prostacyclin (PGI2). The PGs were measured by specific isotope-labelled immunoassay after separation with a silicic acid colum. Results: 1) In the HV group, there was a significant positive correlation between age and the TxB2 level and TXB2/6-keto-PGF1α ratio, and there was a significant negative correlation between age and 6-keto-PGF1α level. 2) In the UD group, the TXB2 level was high and the 6-keto-PGF1α level was low. However, in the MD group, the TXB2 level was not so high and 6-keto-PGF1α level was not particularly low. Also in the UD group, TXB2/6-keto-PGF1α ratio was significantly high in comparison with the MD group. These results suggested that an imbalance between PGs was found in ESRD patients, and that the introduction of dialysis therapy improved this abnormality. It was also apparent that in ESRD patients, the PGF2α level was high. 3) The 6-keto-PGF1α level was low in the undialyzed hypertensive patients and high in the dialyzed hypotensive patients. There was a significant negative correlation between the 6-keto-PGF1α level and blood pressure. There was also a significant negative correlation between dialysis patient month and blood pressure, and a positive correlation between dialysis patient month and the 6-keto-PGF1α level. These results suggested that PGI2 played a pathophysiological role in hypertension and hypotension in addition to renin and volume factors. 4) There was a significant positive correlation between PWV value and the TXB2 level and TXB2/6-keto-PGF1α ratio. There were also significant correlations between the 6-keto-PGF1α level and the level of total cholesterol triglyceride, phospholipid and β-lipoprotein. These results suggested that TXA2 and PGI2 play a pathophysiological role in atherosclerosis.