NDT Advance Access published online on November 19, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp598
Association of inflammation and protein-energy wasting with endothelial dysfunction in peritoneal dialysis patients
1 Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea 2 Department of Internal Medicine, Yong-In Severance Hospital, Yong-In, Korea 3 Department of Internal Medicine, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea
Correspondence and offprint requests to: Dae-Suk Han; E-mail: dshan{at}yuhs.ac
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Abstract |
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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 s\ 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 subgrouped 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.
Keywords: endothelial dysfunction; inflammation; peritoneal dialysis; protein-energy wasting
* These authors contributed equally to this work.