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- Title
Association of inflammation and protein-energy wasting with endothelial dysfunction in peritoneal dialysis patients.
- Authors
Hoon Young Choi; Jung Eun Lee; Seung Hyeok Han; Tae Hyun Yoo; Beom Seok Kim; Hyeong Cheon Park; Shin-Wook Kang; Kyu Hun Choi; Sung Kyu Ha; Ho Yung Lee; Dae-Suk Han
- Abstract
Background. Cardiovascular disease is the main cause of mortality in end-stage renal disease (ESRD) patients. Recent studies have indicated that non-traditional risk factors such as endothelial dysfunction (ED), chronic inflammation and protein-energy wasting (PEW) may contribute significantly to the increased cardiovascular mortality among dialysis patients. To further ascertain this association, we carried out a cross-sectional assessment of nutritional status, inflammatory markers and endothelial dysfunction in peritoneal dialysis (PD) patients. Methods. We measured ED functionally by flow-mediated vasodilatation (FMD) using doppler ultrasonography and biochemically by soluble intercellular adhesion molecule-1 (sICAM-1) in 105 stable PD patients and 32 age- and sex-matched healthy controls. We also simultaneously measured inflammatory markers and performed a subjective global assessment (SGA) of their nutritional status using a seven-point scoring scale. Subjects were sub grouped according to their nutritional and inflammatory status. Results. In PD patients, FMD was markedly lower (9.9 ± 4.8% vs. 16.4 ± 4.8%, P < 0.05), and sICAM-1 was significantly higher than those in controls. The malnourished patients had significantly lower FMD (8.4±4.6% vs. 10.8±4.7%, P <0.05) and higher sICAM-1 than the nourished patients. The inflamed group had significantly lower FMD (7.1 ± 3.8 vs.11.1 ± 4.6%, P < 0.05) and higher sICAM-1 than the non-inflamed group. In all PD patients, lean body mass/body weight %, albumin and SGA correlated positively with FMD (r = +0.207, r = +0.224, r = +0.285, P < 0.05). However, age, log high sensitivity C-reactive protein (hsCRP), log IL-6 and sICAM-1 were negatively correlated with FMD (r = −0.275, r = −0.361, r = −0.360, r = −0.271, P < 0.05). A multiple regression analysis showed that log hsCRP was an independent factor affecting FMD. Endothelial function, demonstrated as FMD and sICAM-1 in the nourished PD patients without inflammation, was well preserved compared to other subgroups. Conclusion. Our data suggest that chronic inflammation and PEW are closely linked to ED in PD patients.
- Publication
Nephrology Dialysis Transplantation, 2010, Vol 25, Issue 4, p1266
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gfp598