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Dahan I, Farber E, Thauho N, Nakhoul N, Francis A, Awawde M, Levy AP, Kim-Shapiro DB, Basu S, Nakhoul F. Interaction between the Haptoglobin 2 Phenotype and Diabetes Mellitus on Systolic Pulmonary Arterial Pressure and Nitric Oxide Bioavailability in Hemodialysis Patients. J Diabetes Res 2015; 2015:613860. [PMID: 26171400 PMCID: PMC4481085 DOI: 10.1155/2015/613860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 05/22/2015] [Accepted: 05/26/2015] [Indexed: 01/22/2023] Open
Abstract
Elevated systolic pulmonary artery pressure (s-PAP, ≥35 mmHg) serves as an independent predictor of mortality in hemodialysis (HD) and diabetic (DM) patients. A polymorphism in the antioxidant Haptoglobin (Hp) gene has been shown to regulate the bioavailability of nitric oxide (NO), a major mediator of pulmonary vascular tone. We therefore set out to test the hypothesis that the Hp polymorphism may be a determinant of developing elevated s-PAP specifically in the DM state due to a decreased bioavailability of NO. To test our hypothesis we Hp typed and performed transthoracic echocardiography on a series of HD patients and stratified them into elevated and normal s-PAP groups and then evaluated whether there was a significant association between the Hp type, elevated s-PAP, and decreased NO bioavailability as defined by low plasma nitrite. We found a statistically significant interaction between the Hp type and DM on the prevalence of elevated s-PAP and lower mean nitrite levels with the combination of elevated s-PAP and low nitrite levels being significantly more prevalent in Hp 2-2 DM individuals. We conclude that the Hp 2 type is associated with elevated s-PAP levels and low plasma nitrite levels in HD patients specifically in the DM state.
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Affiliation(s)
- Inbal Dahan
- Diabetic Nephropathy Laboratory, The Baruch Padeh Poriya Medical Center, Faculty of Medicine in the Galilee, 15208 The Lower Galilee, Israel
| | - Evgeny Farber
- Division of Nephrology & Hypertension, The Baruch Padeh Poriya Medical Center, Faculty of Medicine in the Galilee, 15208 The Lower Galilee, Israel
| | - Nadia Thauho
- Diabetic Nephropathy Laboratory, The Baruch Padeh Poriya Medical Center, Faculty of Medicine in the Galilee, 15208 The Lower Galilee, Israel
| | - Nakhoul Nakhoul
- Division of Nephrology & Hypertension, The Baruch Padeh Poriya Medical Center, Faculty of Medicine in the Galilee, 15208 The Lower Galilee, Israel
| | - Adi Francis
- Division of Vascular Medicine, Holy Family Hospital, 16234 Nazareth, Israel
| | - Mohamad Awawde
- Division of Vascular Medicine, Holy Family Hospital, 16234 Nazareth, Israel
| | - Andrew P. Levy
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 31096 Haifa, Israel
| | - Daniel B. Kim-Shapiro
- Department of Physics and Translational Science Center, Wake Forest University, Reynolda Campus, Winston-Salem, NC 27109, USA
| | - Swati Basu
- Department of Physics and Translational Science Center, Wake Forest University, Reynolda Campus, Winston-Salem, NC 27109, USA
| | - Farid Nakhoul
- Diabetic Nephropathy Laboratory, The Baruch Padeh Poriya Medical Center, Faculty of Medicine in the Galilee, 15208 The Lower Galilee, Israel
- Division of Nephrology & Hypertension, The Baruch Padeh Poriya Medical Center, Faculty of Medicine in the Galilee, 15208 The Lower Galilee, Israel
- *Farid Nakhoul:
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