Abstract
Endothelial dysfunction is associated with diabetic micro- and macroangiopathy as well as with the decline in creatinine clearance. It has been suggested that endothelial dysfunction presents in patients (pts) on continuous ambulatory peritoneal dialysis (CAPD). The objective of this study was to examine the plasma biomarkers of endothelial dysfunction and their association with IMT of carotid arteries in diabetic and non-diabetic patients on CAPD. This study included 37 CAPD pts (25 with type II diabetes and 12 non-diabetic pts) mean age 59.2 years ± 2.48. Plasma von Willebrand factor (vWF) activity, serum albumin, glucose, total cholesterol, triglycerides and lipoprotein (a) levels, as well as serum level of homocysteine, parathyroid hormone (PTH) in plasma and microalbuminuria was determined. Ultrasound examination of carotid arteries was performed in all patients by measured bilateral intima-media thickness of carotid artery (CIMT). Mean IMT value was significantly higher in type 2 DM patients (0.86 ± 0.04 mm) compared to non-diabetic patients (0.52 ± 0.06 mm) on peritoneal dialysis (p<0.0001). There was also a significant difference in lipids /triglycerides and Lp (a)/, procoagulation (fibrinogen, von Wilebrand factor, factor VIII) and inflammatory markers (CRP) level between type 2 DM and non-diabetic CAPD patients. A stepwise multiple regression analysis revealed that log triglycerides and factor VIII were independent factors for the IMT. The results of this research impose that diabetic type 2 CAPD patients have developed systemic alteration of endothelial function and higher risk of cardiovascular complications compared to non-diabetic CAPD patients.
Highlights
Due to the significant increase in cardiovascular morbidity and mortality in patients with terminal renal failure, yet more than two decades ago, it was hypothesized about "accelerated atherosclerosis" in such patient population
It has been suggested that endothelial dysfunction presents in patients on continuous ambulatory peritoneal dialysis (CAPD)
The aim of this study was to examine the concentration of fibrinogen, von Willebrand factor, factor VIII and homocysteine in plasma as biomarkers of endothelial dysfunction and their association with intima-media thickness (IMT) of carotid arteries in diabetic and nondiabetic patients on CAPD, as well as the correlation of IMT with uremia associated and other traditional risk factors inherent in the presence of vascular endothelial dysfunction, which, with its endocrine and paracrine function, represent an important organ in maintaining cardiovascular homeostasis
Summary
Due to the significant increase in cardiovascular morbidity and mortality in patients with terminal renal failure, yet more than two decades ago, it was hypothesized about "accelerated atherosclerosis" in such patient population. Recent studies suggest that measuring the concentration of specific vasoactive substances, or biomarkers in plasma, such as von Willebrand factor, factor VIII, fibrinogen, homocysteine, along with traditional and uremia specific risk factors, can predict the existence of endothelial dysfunction and development of micro and macrovascular changes [ , ]. Yilmaz et al [ ], which included patients at different stages of chronic kidney disease, endothelial dysfunction was confirmed in all stages of chronic kidney disease, with a strict correlation with the degree of reduction in glomerular filtration rate.
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