Preliminary study of hypoxia-related cardiovascular mediator-markers in patients with end-stage renal disease with and without diabetes and the effects of haemodialysis

BACKGROUND

Evidence points to activation of pro-inflammatory and pro-thrombotic stimuli during the haemodialysis process in end-stage renal disease (ESRD) with potential to predispose to cardiovascular events. Diabetes is associated with a higher incidence of cardiovascular disease in haemodialysis patients. We tested the hypothesis that a range of mediators and markers that modulate cardiovascular risk are elevated in haemodialysis patients with diabetes compared to those without.

METHODS

Men and women with diabetes (n = 6) and without diabetes (n = 6) aged 18-90 years receiving haemodialysis were recruited. Blood samples were collected and analysed pre- and post-haemodialysis sessions for (platelet-monocyte conjugates (PMC), oxidised LDL (Ox-LDL), endothelin 1 (ET-1) and vascular endothelial growth factor (VEGF-A).

RESULTS

PMC levels significantly increased after haemodialysis in both groups (diabetes p = 0.047; non-diabetes p = 0.005). Baseline VEGF-A was significantly higher in people with diabetes (p = 0.009) and post-dialysis levels were significantly reduced in both groups (P = 0.002). Ox-LDL and CRP concentrations were not significantly different between groups nor affected in either group post-dialysis. Similarly, ET-1 concentrations were comparable in all patients at baseline, with no change post-dialysis in either group.

CONCLUSIONS

In this pilot study, we have confirmed that circulating PMCs are increased following dialysis irrespective of diabetes status. This is likely to be a mechanistic process and offers a potential explanation for high rates of vascular events associated with haemodialysis. The higher VEGF-A concentrations between patients with and without diabetes is a previously unreported finding in diabetic ESRD. Further research is merited to establish whether VEGF-A is a marker or mediator (or both) of cardiovascular risk in haemodialysis.

On the applicability of CCSD(T) for dispersion interactions in large conjugated systems

In light of the recent discrepancies reported between fixed node diffusion Monte Carlo and local natural orbital coupled cluster with single, double, and perturbative triples [CCSD(T)] methodologies for non-covalent interactions in large molecular systems [Al-Hamdani et al., Nat. Commun. 12, 3927 (2021)], the applicability of CCSD(T) is assessed using a model framework. The use of the semi-empirical π-space only Pariser-Parr-Pople (PPP) model for studying large molecules is critically examined and is shown to recover both bandgap closure as system size increases and long range dispersive behavior of r-6 with increasing separation between monomers. Since bandgap closure in systems with long-range Coulomb interactions is problematic for perturbative methods, such as CCSD(T), this model, therefore, serves as a testing ground for such methods, enabling them to be benchmarked with high-order CC methods, which are not possible with ab initio Hamiltonians. Using the PPP model, coupled cluster methodologies, CCSDTQ and CCSDT(Q), are then used to benchmark CCSDT and CCSD(T) methodologies for non-covalent interactions in large one- and two-dimensional molecular systems up to the dibenzocoronene dimer. We show that CCSD(T) demonstrates no signs of overestimating the interaction energy for these systems. Furthermore, by examining the Hartree-Fock HOMO-LUMO gap of these large molecules, the perturbative treatment of the triples contribution in CCSD(T) is not expected to cause problems for accurately capturing the interaction energy for system sizes up to at least circumcoronene.