Risk factors associated with brachial–ankle pulse wave velocity among peritoneal dialysis patients in Macao

BMC Nephrology

Jing Xin¹  Weng-In Lio²  Kin Cheung²  Un-I Kuok²  Chiu-Leong Li²  Ding-Wei Kuang¹ 

[1]Divion of Nephrology, Huashan Hospital, Fudan University, Shanghai, PR China

[2]Divion of Nephrology, Centro Hospitalar Conde de São Januário, Macao SAR, PR China

关键词: Peritoneal dialysis;    Cardiovascular disease;    Pulse wave velocity;    Arterial stiffness;   

Others  :  1083068
DOI  :  10.1186/1471-2369-13-143

 received in 2012-07-31, accepted in 2012-10-28,  发布年份 2012

【 摘 要 】

Background

Cardiovascular disease is the leading cause of mortality among peritoneal dialysis (PD) patients in Macao. Increased arterial stiffness determined by pulse wave velocity (PWV) has been established as an independent predictor of cardiovascular mortality in end-stage renal disease patients. The present study aims to investigate the relationship between arterial stiffness and its associated risk factors in chronic PD patients.

Methods

A total of 96 chronic PD patients (48 males/48 females) were included in the cross-sectional study. Arterial stiffness was assessed by brachial-ankle PWV (baPWV). Patients were divided into two subgroups according to mean baPWV value. On enrollment, clinical characteristics and biochemical parameters were collected.

Results

Compared with low baPWV group patients, high baPWV group patients were significant older (p<0.001) and more likely to have a high proportion of female gender (p=0.004) as well as previous CVD history (p=0.008). Serum albumin, pre-albumin levels and residual renal creatinine clearance (CCr) were significantly lower but the serum ferritin level was significantly higher in high baPWV group patients than in low baPWV group patients (all p<0.01). BaPWV was positively associated with age (r=0.534, p<0.001), Charlson comorbidity index (r=0.350, p<0.001) and serum ferritin level (r=0.340, p=0.001). Meanwhile, baPWV negatively correlated with serum albumin (r=−0.479, p<0.001), pre-albumin levels (r=−0.320, p=0.003) and residual renal CCr (r=−0.177, p=0.048). Age-adjusted partial correlation test found a significant correlation between baPWV and CRP (r=0.462, p<0.001). Multivariate regression analysis showed that baPWV was independently associated with age (p<0.001), serum albumin level (p=0.015),CRP (p=0.019) and residual renal CCr (p=0.045).

Conclusion

Arterial stiffness, assessed by baPWV, had an independent correlation with age, serum albumin level, CRP level and residual renal CCr among PD patients in Macao.

【 授权许可】

   
2012 Kuang et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Li CL, Cui TG, Gan HB, Cheung K, Lio WI, Kuok UI: A randomized trail comparing conventional swan-neck straight-tip catheters to straight-tip catheter with an artificial subcutaneous swan neck. Perit Dial Int 2009, 29(3):278-284.
• [2]Sidhu MS, Dellsperger KC: Cardiovascular problems in dialysis patients: impact on survival. Adv Perit Dial 2010, 26:47-52.
• [3]United States Renal Data System: USRDS 2010 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. Bethesda, MD: United States Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Division of Kidney, Urology, and Hematologic Diseases; 2010.
• [4]Ho WY, Chau KF, Choy BY, Fung KS, Cheng YL, Kwan TH, Wong PN, Lai WM, Yong SP, Lo HK, Chan CK, Leung CB: Hong Kong renal registry report 2010. Hong Kong J Nephrol 2010, 12(2):81-98.
• [5]Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM: Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 2001, 38(4):938-942.
• [6]London GM, Guerin AP, Marchais SJ, Metivier F, Pannier B, Adda H: Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality. Nephrol Dial Transplant 2003, 18(9):1731-1740.
• [7]Chen SC, Chang JM, Liu WC, Tsai YC, Tsai JC, Hsu PC, Lin TH, Lin MY, Su HM, Hwang SJ, Chen HC: Brachial-ankle pulse wave velocity and rate of renal function decline and mortality in chronic kidney disease. Clin J Am Soc Nephrol 2011, 6(4):724-732.
• [8]Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A: Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 2001, 37:1236-1241.
• [9]Sugawara J, Hayashi K, Yokoi T, Cortez-Cooper MY, DeVan AE, Anton MA, Tanaka H: Brachial-ankle pulse wave velocity: an index of central arterial stiffness? J Hum Hypertens 2005, 19(5):401-406.
• [10]Yamashina A, Tomiyama H, Arai T, Hirose K, Koji Y, Hirayama Y, Yamamoto Y, Hori S: Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk. Hypertens Res 2003, 26(8):615-622.
• [11]Zhe XW, Tian XK, Chen W, Guo LJ, Gu Y, Chen HM, Tang LJ, Wang T: Association between arterial stiffness and peritoneal fluid kinetics. Am J Nephrol 2008, 28(1):128-132.
• [12]Gu Y, Cheng LT, Chen HM, Sun XY, Tang LJ, Guo LJ, Axelsson J, Wang T: Strong association between nutritional markers and arterial stiffness in continuous ambulatory peritoneal dialysis patients. Blood Purif 2008, 26(4):340-346.
• [13]Jung JY, Hwang YH, Lee SW, Lee H, Kim DK, Kim S, Oh YG, Yang J, Joo KW, Ahn C, Oh KH: Factors associated with aortic stiffness and its change over time in peritoneal dialysis patients. Nephrol Dial Transplant 2010, 25(12):4041-4048.
• [14]Szeto CC, Kwan BC, Chow KM, Leung CB, Law MC, Li PK: Prognostic value of arterial pulse wave velocity in peritoneal dialysis patients. Am J Nephrol 2012, 35(2):127-133.
• [15]Beddhu S, Zeidel ML, Saul M, Seddon P, Samore MH, Stoddard GJ, Bruns FJ: The effects of comorbid conditions on the outcomes of patients undergoing peritoneal dialysis. Am J Med 2002, 112(9):696-701.
• [16]Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, Koji Y, Hori S, Yamamoto Y: Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement. Hypertens Res 2002, 25(3):359-364.
• [17]Wang AY: Cardiovascular risk factors in peritoneal dialysis patients revisited. Perit Dial Int 2007, 27(Suppl 2):S223-S227.
• [18]Willum-Hansen T, Staessen JA, Torp-Pedersen C, Rasmussen S, Thijs L, Ibsen H, Jeppesen J: Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population. Circulation 2006, 113(5):664-670.
• [19]Sipahioglu MH, Kucuk H, Unal A, Kaya MG, Oguz F, Tokgoz B, Oymak O, Utas C: Impact of arterial stiffness on adverse cardiovascular outcomes and mortality in peritoneal dialysis patients. Perit Dial Int 2012, 32(1):73-80.
• [20]Kendrick J, Teitelbaum I: Strategies for improving long-term survival in peritoneal dialysis patients. Clin J Am Soc Nephrol 2010, 5(6):1123-1131.
• [21]Bergstrom J, Lindholm B: Malnutrition, cardiac disease, and mortality: an integrated point of view. Am J Kidney Dis 1998, 32(5):834-841.
• [22]Kiykim AA, Camsari A, Kahraman S, Arici M, Altun B, Cicek D, Erdem Y, Yasavul U, Turgan C, Caglar S, Oto A: Increased incidence of carotid artery wall changes and associated variables in hemodialysis patients without symptomatic cardiovascular disease. Yonsei Med J 2004, 45(2):247-254.
• [23]Danielski M, Ikizler TA, McMonagle E, Kane JC, Pupim L, Morrow J, Himmelfarb J: Linkage of hypoalbuminemia, inflammation, and oxidative stress in patients receiving maintenance hemodialysis therapy. Am J Kidney Dis 2003, 42(2):286-294.
• [24]Akdag I, Yilmaz Y, Kahvecioglu S, Bolca N, Ercan I, Ersoy A, Gullulu M: Clinical value of the malnutrition-inflammation-atherosclerosis syndrome for long-term prediction of cardiovascular mortality in patients with end-stage renal disease: a 5-year prospective study. Nephron Clin Pract 2008, 108(2):c99-c105.
• [25]Choi HY, Lee JE, Han SH, Yoo TH, Kim BS, Park HC, Kang SW, Choi KH, Ha SK, Lee HY, Han DS: Association of inflammation and protein-energy wasting with endothelial dysfunction in peritoneal dialysis patients. Nephrol Dial Transplant 2010, 25(4):1266-1271.
• [26]Krediet RT, Balafa O: Cardiovascular risk in the peritoneal dialysis patient. Nat Rev Nephrol 2010, 6(8):451-460.
• [27]Wang AY, Woo J, Lam CW, Wang M, Sea MM, Lui SF, Li PK, Sanderson J: Is a single time point C-reactive protein predictive of outcome in peritoneal dialysis patients? J Am Soc Nephrol 2003, 14(7):1871-1879.
• [28]Perl J, Bargman JM: The importance of residual kidney function for patients on dialysis: a critical review. Am J Kidney Dis 2009, 53(6):1068-1081.
• [29]Bargman JM, Thorpe KE, Churchill DN, CANUSA Peritoneal Dialysis Study Group: Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol 2001, 12(10):2158-2162.
• [30]Marron B, Remon C, Perez-Fontan M, Quiros P, Ortiz A: Benefits of preserving residual renal function in peritoneal dialysis. Kidney Int 2008, 73(Suppl 108):S42-S51.