An Analysis Of Risk Factors Of Carotid Atherosclerosis In Chronic Kidney Disease

Objective To analyze the risk factors of carotid atherosclerosis in diabetic kidney disease.Methods 20 patients with CKD1-2,20 patients with CKD3-4,20 non-dialyzed patients with CKD5,15 patients with hemodialysis(HD),15 patients with peritoneal dialysis (PD) and 13 normal adults were enrolled in the study(diagnosis and staging according to K/DOQI 2003 guidelines). Serum malondialdehyde(MDA), superoxide dismutase(SOD), myeloperoxidase(MPO), interleukin-1β(IL-1β), interleukin-6(IL-6), oxidation low-density lipoprotein (ox-LDL) levels were assayed. The intima-medial thickness(IMT), atherosclerotic plaques, pressure-strain elastic modulus (Ep) and stiffness index (SI) were measured and calculated of common carotid artery by using high-resolution B-mode ultrasonography, and clinical and biochemical parameter was record.Results In the comparison with the control group, the levels of GLU,TG,LDL-C,LP(a),SUA,PTH,SBP,PP,MPO,MDA,SOD,ox-LDL,IL-6,CRP were higher in each group of CKD patients (P<0.05 or P<0.001), P,Ca×P were higher in CKD 5 group (P<0.05 or P<0.001), HB, ALB, TBIL decreased in CKD patients (P<0.05 or P<0.001); Levels of ALB,PA,MPO was increased in HD than PD (P<0.05 or P<0.001); the average thickness of IMT, plaque incidence, Ep and SI in CKD patients was higher than the healthy control group (P<0.01 or P<0.001) Correlation analysis showed that there were positive correlations between IMT, Ep, SI and PTH, SBP, PP, TG, LP(a), MDA, SOD, MPO, ox-LDL, IL-6, CRP (P<0.05 or P<0.001), negative correlations between IMT, Ep, SI and HB,ALB,TBIL (P<0.05 or P<0.001)Conclusions 1. There are Hyperglycemia, hypertension, Dyslipidaemia, Hyperuricemia, Low hyperbilirubinemia, anemia, malnutrition, calcium and phosphorus metabolism disorders, high PTH,oxidative stress,microinflammation in all stages of CKD development, and it become increased following renal function decrease.2. The IMT, plaque incidence, Ep and SI was gradually increased as renal function decreased.3. Hyperuricemia, Low hyperbilirubinemia, anemia, malnutrition, calcium and phosphorus metabolism disorders, high PTH,oxidative stress,microinflammation form an dangerous environment for carotid atherosclerosis.4. There was no difference of CAS and microinflammation between HD and PD apart from MPO is increased in HD than PD.5. As renal function gradually decresed, oxidative stress is accompanied with antioxidant capacity increased.