Peritoneal Dialysis Patients With Malnutrition And Cardiovascular Disease Relationship

Objective To research the assosiation between E/T (extracellular water to-total body water ratio) and pulse wave velocity (PWV) in patients on continuous ambulatory peritoneal dialysis(CAPD). Methods Clinical stable CAPD patients (n=56, 26M/30F) in a single center were included. Carotid-femoral PWV was measured with a validated automatic device and was used as an index of large arterial stiffness. Multiple-frequency bioelectrical impedance analysis was used to record the values for ECW, intracellular water (ICW), and total-body water. Based on these data, E/T also was calculated. In addition, some biochemical indices, such as serum albumin, blood urea nitrogen, serum creatinine, serum triglycerides, total cholesterol lipoprotein, low-density lipoprotein, high-density lipoprotein, alanine and aspartate transaminase etc were determined with standard methods. Pearson' s correlation and multiple regression analysis were performed to identify the relationship between E/T and PWV. Results PWV was strongly associated with E/T (r=0. 454, p=0. 001), E/I (r=0. 456, p=0. 001), pulse pressure (PP) ( r=0. 649 , p<0. 001), age (r=0. 404, p=0. 002), serum albumin (r=-0. 346, p=0. 01) and CRP (r=0. 327, p=0. 025) , respectively. Multiple regression analysis showed that PWV was independently determined by E/T (β=0.472, P =0. 001), PP(β=0. 442, P=0. 001) and CRP( β=0. 246, P=0. 05). They accounted for 58. 1% of the total variance and E/T alone reprensented 37. 8% of the explained variance. The regression equation: Y=-7. 064+29. 04X₁+0. 051X₂+0. 077X₃ (X₁ =E/T, X₂=PP, X₃=CRP) Conclusion E/T was closely associated with PWV in peritoneal dialysis patients. E/T, in addition to PP and CRP, was an independent risk factor for elevated PWV in CAPD patients, suggesting that increased arterial stiffness might be the link between fluid overload and cardiovascular events and mortality in dialysis patients. Objective Hypoalbuminemia has been shown as a risk factor for cardiovascular events and mortality in dialysis patients but the underlying mechanism remained inconclusive. The aim of the present study was to assess the association between serum albumin and pulse wave velocity (PWV)—the marker of arterial stiffness in a group of patients on continuous ambulatory peritoneal dialysis (CAPD). Methods Clinical stable CAPD patients (n=62) in a single center was included. Of the 62 patients studied, 43.5% were men. The average age was 63 ± 12 years and mean dialysis duration was 23±22 months. Serum albumin, C-reactive protein (CRP) and carotid-femoral PWV were measured. Results Of the 62 patients studied, 43. 5% were men. The mean serum albumin concentration of total subjects was 37±4g/L, and PWV was 11.9 ± 2.3m/s. PWV was positively correlated with age (r=0.35, P<0.01), diabetic status (yes=1, no=0; r=0.292, P <0.05), SBP (r =0. 493, P <0. 001) and CRP (r=0. 295, P <0. 05), but negatively correlated with serum albumin (r=-0.357, P<0.01). In stepwise multiple regression analysis, systolic blood pressure (β=0.615, P<0.001), age (β=0.414, P<0.01), serum albumin (β=-0.315, P<0.05) and total cholesterol (β=0.275, P<0.05) were independent determinants of PWV after adjusting gender, height, diabetic status, dialysis duration, diastolic blood pressure, antihypertensive medication, C-reactive protein, calcium concentration and total cholesterol (adjusted R square=0.627). Conclusion The independent association between serum albumin and pulse wave velocity suggested that increased arterial stiffness might be the link between hypoalbuminemia and increased cardiovascular events and mortality in dialysis patients. Objective To validate the hypothesis that the possible link between hypoalbuminemia and cardiovascular disease was arterial stiffness. Methods Clinical stable CAPD patients (n=184, 83M/101F) in a single center was included. Serum albumin, C-reactive protein (CRP) and brachial blood pressure were measured. Pearson's correlation and multiple regression analysis were performed to identify the relationship between hypoalbuminemia and PP. In addition, patients were divided into two groups according to the serum albumin concentration: hypoalbuminemia group (<35g/L) and normal-albumin group (≥35g/L). The two groups were matched in age, sex,diabetes,antihypertensive medication, serum lipid and so on,then 132 patients remained. There were 60 patients in hypoalbuminenia group and 72 in normal-albumin group. Results PP in hypoalbuminemia group was significantly higher than that in normal-albumin group (67±17 vs. 55±17 mmHg, P<0.01). Serum albumin was negatively associated with systolic blood pressure (r=-0.211, P<0.01) and PP (r=-0.281, P<0.001), respectively. Multiple regression analysis showed that PP was determined by age (odds ratio=0.451, P<0.05), body mass index (odds ratio=1.703, P<0.05) and serum albumin (odds ratio=-2.492, P<0.01). Conclusion Hypoalbuminemia was closely associated with increased pulse pressure in peritoneal dialysis patients. Serum albumin, in addition to age and body mass index, was an independent risk factor for elevated pulse pressure in CAPD patients, suggesting that increased arterial stiffness might be the link between hypoalbuminemia and cardiovascular events and mortality in dialysis patients. Objective To research the assosiation between E/T (extracellular water to-total body water ratio) and pulse pressure (PP) in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods Clinical stable CAPD patients (n=74, 32M/42F) were included. Brachial blood pressure was measured twice in sitting position after patients had rested more than ten minutes. PP was calculated as systolic blood pressure (SBP) minus diastolic blood pressure (DBP) and it was used as an index of large arterial stiffness. Multiple-frequency bioelectrical impedance analysis was used to record the values for ECW, intracellular water (ICW), and total-body water. Based on these data, E/T also was calculated. In addition, some biochemical indices were determined with standard methods. Pearson' s correlation and multiple regression analysis were performed to identify the relationship between E/T and PP. Results PP was strongly associated with E/T(extracellular water/ total body water) (r=0.691, P <0.001) , E/I (extracellular water/intracellular water) (r=0.456,p=0.001),SBP (r=0.78, P<0.001) , DBP, (r =-0.402, P<0.001), age (r=0.427, P<0.001) , serum albumin (r=-0.36, P=0.002) , C-reactive protein( CRP) (r =0.367, P=0.008) and diabetes (r=0.25, P=0.031) , respectively. Multiple regression analysis showed that PP was independently determined by E/T ( β=0. 67, P<0.001) and CRP(β=0. 253, P =0.016). They accounted for 55.7% of the total variance and E/T alone reprensented 50.4% of the explained variance. The regression equation: Y=-111. 81+326.361X₁+0.584X₂(Y=PP;X₁=E/T;X₂= CRP) Conclusion E/T was closely associated with PP in peritoneal dialysis patients. E/T, in addition to CRP, was an independent risk factor for elevated PP in CAPD patients, suggesting that increased arterial stiffness might be the link between fluid overload and cardiovascular events and mortality in dialysis patients.