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Background  Left ventricular hypertrophy (LVH) is commonly found in chronic dialysis (CD) recipients, and is associated with impaired microvascular cardiac perfusion and heart failure. In response to LVH and cardiac ischemia, early outgrowth pro-angiogenic cellS(EPCs) mobilize from the bone marrow to facilitate angiogenesis and endothelial repair. In the general population, EPC number and function correlate inversely with cardiovascular risk. In end-stage renal disease (ESRD), EPC number and function are generally reduced.    Objectives  To test whether left ventricular abnormalities retain their potent ability to promote EPC reparative responses in the setting of ESRD.    Design  Cross-sectional study.    Setting  St. Michael’s Hospital, Toronto, Ontario, Canada.    Patients  47 prevalent chronic dialysis recipients.    Measurements  (1) circulating CD34 +  and CD133 +  EPC number, (2) cultured EPC migratory ability,  in vitro  differentiation potential, and apoptosis rate, and (3) cardiac magnetic resonance-measured LV mass, volume and ejection fraction.    Methods  Bivariate correlation analysis was performed with Spearman's rho test.    Results  Of the 47 patients (mean age: 54 ± 13 years), the mean delivered urea reduction was 74 ± 10 %. Mean LV mass was 123 ± 38 g. Circulating CD34 +  and CD133 +  EPCs represented 0.14 % (IQR: 0.05 – 0.29 %) and 0.05 % (IQR: 0.01 – 0.10 %) of peripheral blood mononuclear cells. There were no significant correlations between any EPC parameter and measures of LV mass or ejection fraction.    Limitations  Lack of a non-ESRD control population, and the inability to measure all parameters of EPC function due to limitations in blood sampling. Our inability to measure cardiac VEGF expression prevented an assessment of changes in cardiac EPC mobilization signals.    Conclusions  These data suggest that in ESRD, the reparative EPC response to cardiac hypertrophy may be blunted. Further investigation of the effects of uremia on EPC physiology and its relationship to cardiac injury are required.

canadian journal of kidney health and disease

Early Outgrowth Pro-Angiogenic Cell Number and Function Do Not Correlate with Left Ventricular Structure and Function in Conventional Hemodialysis Patients: A Cross-Sectional Study