Correlation Between Atherogenic Index Of Plasma And Cardiovascular Risks In Peritoneal Dialysis Patients

OBJECTIVE:The present study aimed to evaluate dyslipidemia in peritoneal dialysis patients by atherogenic index of plasma (AIP).10-year risk of cardiovascular disease (Framingham risk score, FRS) and its influencers, its relationship with AIP, and influence factors of AIP in peritoneal dialysis patients were analyzed to provide basis for management of lipid metabolic disorders and preventing cardiovascular events in these patients.METHODS:PD group included 129 peritoneal dialysis patients who were collected from peritoneal dialysis center of Second Affiliated Hospital of Kunming Medical University from January 2014 to December 2015. From the same hospital 134 healthy adults were setup as control group who were collected randomly in the same period using same criteria. Patients from PD group were divided into four groups according to the age quartiles:Age-Q1 (Age<41):30 cases; Age-Q2 (41≤Age<50):34 cases; Age-Q3 (50≤Age<60):34 cases; Age-Q4 (Age>60):31 cases, were divided into two groups according to gender:Male 77 cases. Female 52 cases; were divided into three groups according to Framingham risk score:Low-risk (FRS<10%):43 cases. Intermediate risk (10%≤FRS<20%):34 cases. High risk (FRS>20%):52 cases, and were divided into three groups according to the AIP quartiles:AIP-Q1 (AIP<0.043):29 cases. AIP-Q2 (0.043≤AIP<0.230):34 cases. AIP-Q3 (0.230≤AIP<0.393):33 cases, AIP-Q4 (AIP<0.393):33 cases. Data of age, gender, height, weight, smoking history, type of dialysis, dialytic time, primary disease, complication, medication, blood pressure were collected. Morning fasting venous blood samples were obtained to detect levels of serum total protein (TP). albumin (ALB), uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterin (LDL-C), non-high density lipoprotein cholesterol (NONHDL), apolipoprotein Al (APOA1), apolipoprotein B (APOB), hemoglobin. Data were analyzed by IBM SPSS version 23.0, using descriptive statistics, chi-squared, independent-samples t-test, LSD test, one-way analysis of variance (ANOVA), Pearson correlation, Spearman correlation, multiple linear regression, and logistic regression analysis. P<0.05 was accepted as the level of statistical significance.RESULTS:We found that compared with healthy group, level of BMI, total protein (TP), albumin (ALB) of PD group were significantly lower (p<0.05) and level of uric acid (UA) was significantly higher (p<0.001). Compared with healthy group, level of triglyceride (TG), low density lipoprotein cholesterin (LDL-C) of PD group were significantly higher (p<0.05), atherogenic index of plasma(AIP) and TG/HDL-C were also significantly higher (p<0.001), and level of HDL-C was significantly lower(p<0.001), while total cholesterol (TC) non-high density lipoprotein cholesterol (NONHDL) was higher but there is not significant difference. Patients from PD group were divided into four groups according to the age quartiles. Significant differences of diastolic pressure(SD), TG, HDL-C, AIP, TG/HDL-C, APOB were found among the four groups. Compared with Age-Q1, diastolic pressure(DP) of Age-Q2, Age-Q3 is significantly higher (p<0.05) and TG, TG/HDL-C, AIP were significantly higher(p<0.05). APOB of Age-Q3 is significantly higher compared with Age-Q1. Patients from PD group were divided into two groups according to gender, TC, HDL-C, LDL-C, NONHDL, APOA1, APOB level of female casese was significantly higher(p<0.05). Patients from PD group were divided into three groups according to Framingham risk score, peritoneal dialysis patients have risk of cardiovascular diseases of different extent, especially high risk group. Systolic pressure(SP), TG, HDL-C, AIP, TG/HDL-C were significantly different among the three groups and in comparison of AIP, TG/HDL-C P<0.001. Compared with low-risk group, SP of intermediate risk group was significantly higher(p<0.05), TG, AIP, TG/HDLC of were significantly higher, HDL-C was significantly lower. Spearman correlation suggest negative correlation between FRS and AIP with significant difference (r=0.380, P=0.000). Ordinal logistic regression suggested BMI, gender, smoking, diabetes, hypertension reduced residual urine volume and AIP were independent risk factors of cardiovascular diseases. Linear correlation with AIP as the dependent variable suggested AIP was significantly positively correlated with Age (r=0.259, p=0.003), BMI (r=0.181, p=0.04) and negatively correlated with APOA1 (r=-0.439, p=0.000). Age, BMI, NONHDL, APOA1 and LPa were joined in multiple linear regression analysis based on p<0.1. The results of multiple liner regression analysis showed that Age (t=3.029, p=0.003), BMI (t=2.118, p=0.036), APOA1 (t=-6.868, p=0.000), NONHDL(t=3.894, p=0.000) were in the regress equation. The equation is AIP=-0.007+0.005Age+0.012BMI-0.501APOA1+0.084NONHDL. Degree of influencing factors:APOA1>NONHDL>Age>BMI.CONCLUSIONS:1. There was hyperlipidemia in peritoneal dialysis patients which manifests as disorders of size and distribution of lipids components and lipid particles;2.Peritoneal dialysis patients have risk of cardiovascular diseases to different degrees. Except age, gender, BMI, smoking, diabetes, hypertension, elevated AIP and reduced residual urine volume maybe independent risk factors of cardiovascular diseases.3.AIP is useful for evaluation of risk of cardiovascular disease and risk stratification and could be performed as a routine test during follow-up in peritoneal dialysis patients. Joint detection of AIP and NONHDL, APOA1 may help improving its efficacy.