Arterial Stiffness In Peritoneal Dialysis Patients Research Articles

Positive Associations between Adipocyte Fatty Acid-Binding Protein Level and Central Arterial Stiffness in Peritoneal Dialysis Patients.

Background Adipocyte fatty acid-binding protein (A-FABP) plays essential roles in lipolysis, insulin resistance, and atherosclerosis. This study aimed to evaluate the relationship between serum A-FABP levels and carotid-femoral pulse wave velocity (cfPWV) in peritoneal dialysis (PD) patients. Methods This study obtained fasting blood samples from 76 PD patients. A validated tonometry system was used to measure cfPWV. Patients with cfPWV values >10 m/s were classified into the high arterial stiffness group, whereas patients with values ≤10 m/s were classified into the low arterial stiffness group, according to the ESH-ESC 2013 guidelines. Serum A-FABP levels were measured using a commercial enzyme-linked immunosorbent assay kit. Results Twenty-five (32.9%) of the 76 PD patients were classified in the high arterial stiffness group. Compared with the patients in the low arterial stiffness group, the high arterial stiffness group was older (P = 0.002) and had a longer PD vintage (P = 0.011), higher diastolic blood pressure (DBP, P = 0.036), higher fasting glucose levels (P = 0.012), higher serum C reactive protein levels (P = 0.001), and higher serum A-FABP levels (P < 0.001). A multivariate logistic regression analysis of the factors significantly associated with central arterial stiffness revealed that A-FABP (odds ratio (OR): 1.165, 95% confidence interval (CI): 1.056–1.284, P = 0.002), age (OR: 1.423, 95% CI: 1.153–1.757, P = 0.001), PD vintage (OR: 1.049, 95% CI: 1.015–1.085, P = 0.005), and DBP (OR: 1.152, 95% CI: 1.033–1.285, P = 0.011) were independent predictors of central arterial stiffness in PD patients. Furthermore, serum A-FABP levels (β = 0.476, adjusted R2 change: 0.197, P < 0.001) were significantly positively correlated with cfPWV according to the multivariable forward stepwise linear regression analysis. Conclusions A-FABP levels are an independent marker of central arterial stiffness in PD patients.

Association of brachial-ankle pulse wave velocity with cognitive impairment in peritoneal dialysis patients

Background The relationship between cognitive impairment (CI) and arterial stiffness in peritoneal dialysis (PD) patients has not been clearly clarified. The aim of this study was to examine the relationship between CI and arterial stiffness in PD patients. Methods This cross-sectional study enrolled PD patients who performed a vascular profiler test at a single PD center in China between January 2014 and June 2016. The cognitive function was evaluated using the Montreal cognitive assessment (MoCA). A noninvasive vascular screening device was used to assess arterial stiffness relevant indicators. Results A total of 643 PD patients with median age 45 (37–57.4) years and median duration of PD 27.8 (8.7–56.4) months were enrolled. The rate of CI was 49.9%. The mean brachial-ankle pulse wave velocity (baPWV) was 17.2 ± 5.6 m/s. Compared with normal cognitive function group, patients with CI had higher baPWV (18.6 ± 7.0 vs. 15.8 ± 3.2 m/s), systolic blood pressure (150.3 ± 21.5 vs. 144.2 ± 20.2 mmHg), and pulse pressure (59.7 ± 14.7 vs. 52.5 ± 11.6 mmHg), and lower ankle-brachial index (ABI, 1.12 ± 0.12 vs. 1.15 ± 0.09) (all p<.05). Compared with systolic blood pressure, pulse pressure, and ABI in receiver operating characteristic (ROC) analysis, baPWV had better performance in predicting CI (area under curve: 0.68, 95% confidence interval: 0.64–0.72). BaPWV was independently associated with MoCA score (B per SD, −0.42 [95% confidence interval, −0.71 to −0.12]; p = .006) and CI (OR per SD, 1.55 [95% confidence interval, 1.11–2.17]; p = .011) in PD patients after adjustment for confounders. Conclusions Higher baPWV was independently associated with CI in PD patients.

Osteocalcin and carotid-femoral pulse wave velocity in patients on peritoneal dialysis.

Objective:Vascular calcification is a cardiovascular risk factor in dialysis patients. Vascular calcification involves a complex process of biomineralization resembling osteogenesis, which leads to arterial stiffness. Osteocalcin is the most abundant noncollagenous protein in the bone matrix. It is synthesized in the bone by osteoblasts and reflects the rate of bone formation. The aim of this study was to evaluate the relationship between serum osteocalcin levels and the carotid–femoral pulse wave velocity (cfPWV) in peritoneal dialysis (PD) patients.Materials and Methods:Serum intact osteocalcin and cfPWV were measured in 62 PD patients. Those with CfPWV values >10 m/s were defined as the high central arterial stiffness group, while those with values ≤10 m/s were regarded as the low central arterial stiffness group, according to the European Society of Hypertension and of the European Society of Cardiology guidelines.Results:Seventeen of the 62 PD patients (27.4%) were in the high central arterial stiffness group. The high central arterial stiffness group were older (P = 0.002), had a longer PD vintage (P = 0.018), and had higher serum osteocalcin levels (P = 0.001) than those in the low group. Multivariate logistic regression analysis showed that the osteocalcin level (odds ratio: 1.069, 95% confidence interval (CI): 1.005–1.137, P = 0.035), PD vintage (odds ratio: 1.028, 95% CI: 1.010–1.048, P = 0.003), and age (odds ratio: 1.081, 95% CI: 1.005–1.162, P = 0.035) were independently associated with central arterial stiffness in PD patients. Among these patients, cfPWV (β: 0.216, P = 0.001) values and log-transformed intact parathyroid hormone (β: −’0.447, P < 0.001) levels were independently associated with the osteocalcin level in PD patients after multivariate forward stepwise linear regression analysis.Conclusion:Older PD patients with a longer PD vintage and higher serum osteocalcin levels had higher central arterial stiffness as measured by cfPWV. The serum osteocalcin level is an independent marker of central arterial stiffness in PD patients.

The association of fibroblast growth factor 23 with atherosclerosis and arterial stiffness in peritoneal dialysis patients

Aim: Increased serum fibroblast growth factor-23 (FGF-23) levels are associated with adverse cardiovascular events in chronic kidney disease patients. The aim of our study was to investigate the association of FGF-23 with atherosclerosis and arterial stiffness in patients with peritoneal dialysis (PD). Material and Methods: This cross-sectional study was performed in 55 (34 (61.8%) male/21 (38.2%) female) PD patients with a mean age of 53.1±11.4 years. The presence of atherosclerosis was determined by carotid artery-intima media thickness (CA-IMT) and the presence of arterial stiffness was determined by brachial-ankle pulse wave velocity (baPWV). Residual renal function was determined by residual glomerular filtration rate (rGFR), renal creatinine clearance (CCr), and residual urine output. FGF-23 and soluble klotho (s-KL) levels were determined by enzyme-linked immunosorbent assay. Results: CA-IMT (p 2.16. In multiple regression analysis there was an inverse relationship between log10 FGF-23 and rGFR (p = 0.032), residual diuresis (p = 0.048), renal CCr (p = 0.045). There was no relationship with log10 FGF-23 and CA-IMT, baPWV (p > 0.05). Conclusion: Increased atherosclerosis and arterial stiffness were detected in PD patients compared to healthy subjects. There was no relationship between FGF-23 and atherosclerosis and arterial stiffness in PD patients.

Gender-specific associations of skeletal muscle mass and arterial stiffness among peritoneal dialysis patients

Decreased skeletal muscle has been identified as a relevant factor for arterial stiffness but has not been thoroughly investigated in peritoneal dialysis (PD) patients. The aim of this study was to investigate the relationship between skeletal muscle and arterial stiffness in PD patients. A cross-sectional study of 658 prevalent PD patients with a mean brachial-ankle pulse wave velocity (baPWV) of 1714 (±501) cm/s and mean skeletal muscle mass of 26.6 (±5.4) kg was performed. Skeletal muscle mass level was significantly higher in males than in females. When examining skeletal muscle mass as a continuous variable, skeletal muscle mass was significantly associated with baPWV in fully adjusted linear regression models in total patients [standardized coefficients (β), −0.181; 95% confidence interval (95% CI), −0.276 to −0.056; P = 0.003] or female patients (β, −0.119; 95% CI, −0.350 to −0.015; P = 0.03) but not in male patients (β, −0.117; 95% CI, −0.300 to 0.011; P = 0.07). Furthermore, in females, a significant association between the middle or highest tertile of skeletal muscle mass and baPWV was found in fully adjusted models (β, −0.123; 95% CI, −0.204 to −0.008; P = 0.03; β, −0.140; 95% CI, −0.228 to −0.016; P = 0.02, respectively). In conclusion, decreased skeletal muscle mass was independently associated with increased baPWV in PD patients, and this association was significant in females but not in males.

Association of Serum Uric Acid with Arterial Stiffness in Peritoneal Dialysis Patients

Background/Aims: Serum uric acid (SUA) has been proposed as a mediator associated with increased cardiovascular risk and arterial stiffness. However, evidence on the association between SUA and arterial stiffness in peritoneal dialysis (PD) patients is lacking. The aim of this study was to examine the relationship between SUA and arterial stiffness in PD patients. Methods: The patients who performed vascular profiler test from January 1, 2014 to October 31, 2016, and with SUA values were enrolled. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). The relationship between SUA and baPWV was tested by multiple linear regression models. Results: Of 645 PD patients, mean SUA was 6.80 (±1.29) mg/dL, mean baPWV was 1713 (±505) cm/s. In fully adjusted linear regression models, higher SUA was significantly associated with higher baPWV in young [standardized coefficients (β), 0.085; 95% confidence interval (95% CI), 0.013 to 0.130; P=0.02] but not in elderly (β, -0.194; 95% CI, -0.774 to 0.093; P=0.1) PD patients. In gender-stratified models of young patients, there was a significant association between SUA and baPWV in male (β, 0.115; 95% CI, 0.015 to 0.182; P=0.02) but not in female. Male in the highest gender-specific SUA quartile had a higher baPWV than those in the lowest quartile (β, 0.132; 95% CI, 0.011 to 0.209; P=0.03). This gender difference was reversed when selecting male patients with lower SUA levels (quartile 1 and 2) and female patients with higher SUA levels (quartile 3 and 4). Conclusion: SUA was positively associated with baPWV in young PD patients, and this association was significant in males but not in females, which is possibly explained by the higher SUA level in males than in females.

Impact of mean arterial pressure on progression of arterial stiffness in peritoneal dialysis patients under strict volume control strategy

Arterial stiffness is an important contributor to the increased cardiovascular burden of uremia. The aim of the study was to identify determinants of arterial stiffness progression in peritoneal dialysis (PD) patients with strict volume control. 89 prevalent PD patients were enrolled. Assessment of arterial stiffness was performed at baseline and after nine months on average (range 8 - 12 months) by carotid-femoral pulse wave velocity (cf-PWV). Mean age was 51 ± 13 y; preceeding time on PD was 40 ± 34 months. 57% of the patients were men and 9% were diabetic. At baseline, mean cf- PWV was 8.7 ± 2.7 m/s and was significantly higher in patients with diabetes and on automated PD therapy. Cf-PWV was positively correlated with age, history of cardiovascular disease, mean arterial pressure (MAP), blood glucose, left atrium diameter and left ventricular mass index. Sixty patients underwent a second cf-PWV measurement. 36% had progression of arterial stiffness. Delta cf- PWV value was 2.08 ± 1.89 m/s for progressors and -1.25 ± 1.43 m/s; p < 0.01 for nonprogressors (p < 0.01). In logistic regression analysis, the change in MAP was the only predictor for progression of arterial stiffness. MAP is the main determinant of arterial stiffness progression. Our results suggest that efficient blood pressure control may contribute to preserved or reduced arterial stiffness in PD patients.

Clinical correlates of arterial stiffness assessed by the cardio-ankle vascular index in peritoneal dialysis patients

Objective The cardio-ankle vascular index (CAVI) is a novel and accurate method, independent of the effect of blood pressure, and is used as a predictor of arterial stiffness (AS). However, the application of CAVI to identify the prevalence and clinical correlates of AS in peritoneal dialysis (PD) patients remains under investigation. The objective of this study was to explore the clinical correlates of PD patients with AS diagnosed by the CAVI examination compared with PD patients without AS. Materials and Methods A total of 50 patients who had undergone PD for more than 3 months were enrolled in this cross-sectional study. AS was defined as a CAVI ≥ 9. The clinical correlations between CAVI and AS in PD patients were studied. Results These PD patients had a high prevalence (42%) of AS. Age, systolic blood pressure, history of cardiovascular disease, hematocrit, glucose level, and phosphorus level were positively correlated with AS in PD patients compared with those without AS. Furthermore, multivariate regression analysis showed that age [adjusted odds ratio (OR) = 1.116, p = 0.010]; systolic blood pressure (adjusted OR = 1.080, p = 0.010); hematocrit (adjusted OR = 1.896, p = 0.006); and history of cardiovascular disease (adjusted OR = 35.492, p = 0.013) were all independently correlated with AS in PD patients. Conclusion The prevalence of AS in PD patients was high. Older age, elevated systolic blood pressure, hematocrit, and history of cardiovascular disease were positively related to the AS process shown by CAVI assessment in PD patients. However, further studies are needed to elucidate these factors, especially the hematocrit, affecting AS in PD patients after long-term follow-up.

Factors associated with increased pulse wave velocity in peritoneal dialysis patients

Abstract Elevated pulse wave velocity (PWV) reflects increased arterial stiffness. Several studies have investigated PWV in peritoneal dialysis (PD) patients, but direct comparisons with healthy controls were not done. The potential influence of peritoneal transport characteristics on arterial stiffness in PD patients was suggested in recent studies. The aims of this study were to compare PWV in PD patients and healthy volunteers, and to investigate factors associated with increased PWV. The carotid-femoral PWV was measured in 28 PD patients and 28 healthy controls, matched for age and gender. A peritoneal equilibration test (PET) was performed in all PD patients. Based on the PET, patients were classified as: high transporters (H) (n=8), high-average (HA) (n=12), low-average (LA) (n=6), and low transporters (L) (n=2). Six of the PD patients were diabetic. PWV was significantly higher in the PD patients than in the controls (9,9±2,4 vs. 8,0±0,9; p=0,0004). In the PD group, PWV was higher in H/HA than in L/LA patients (10,4 ± 2,5 vs. 8,6 ± 1,0; p=0,008), but all the diabetic patients were in the H/HA group. PWV was significantly higher in diabetic than in non-diabetic PD patients (12,8 ± 2,0 vs. 9,1 ± 1,7; p=0,004). In the PD patients, significant positive correlations were found between PWV and: age, pulse pressure, Kt/V, and duration of PD therapy. In conclusion, the carotid-femoral PWV is elevated in peritoneal dialysis patients. Increased PWV in PD patients is associated with age, diabetic status, and longer duration of PD therapy, but not with this type of peritoneal transport.

Effect of Nutrition on Arterial Stiffness in Peritoneal Dialysis Patients

Background: A poor nutritional state is associated with an increased risk of cardiovascular events in end-stage renal disease. It is unclear whether malnutrition itself can induce cardiovascular disease (CVD). We examined the impact of nutritional status on patients’ arterial stiffness in peritoneal dialysis (PD) patients. Methods: We prospectively enrolled 121 stable PD patients and evaluated them at baseline and 1 year later. According to patients’ Subjective Global Assessment (SGA) changes from baseline to the end, patients were divided into four groups: group 1, SGA from A to B; group 2, SGA remained A, group 3, SGA changed from B to A, and group 4, SGA remained B. Arterial stiffness was assessed by pulse-wave velocity (PWV). Results: At baseline, PWV in well-nourished patients were lower than malnourished patients (p < 0.05). One year later, in group 1, as compared with baseline, PWV increased significantly (p < 0.001) whereas handgrip strength (HGS), daily dietary protein intake and dietary energy intake decreased significantly. In group 3, PWV decreased significantly (p < 0.05) whereas HGS and ALB increased significantly. In groups 1 and 3, lgCRP level remained unchanged. Conclusion: There was a closely longitudinal association between nutritional status and arterial stiffness in PD patients, suggesting a possible impact of nutritional status on arterial function.