Synergism of Malnutrition, Inflammation and Fluid Load in the Development of Atherogenesis in Uremic Patients Undergoing Peritoneal Dialysis

Abstract

Objective: Approximately 50% of end stage renal disease (ESRD) patients lose their lives as a consequence of cardiovascular diseases due to accelerated atherosclerosis. The objectives of this study were to investigate the synergistic effect between nutritional status, inflammation and volume load with atherogenesis estimated using structural and hemodynamic changes in the carotid arteries (CA) in patients on peritoneal dialysis (PD). Methods: Prospective longitudinal study. The study sample consisted of 50 ESRD patients who were treated with PD and were observed for an 18 months after the commencement of dialysis treatment. All examined patients underwent 4 to 5 dialysis changes with 2 liters of dialysis solution. The laboratory findings were complemented with ultrasound of CA and echocardiography at baseline and at the end of follow-up. Results: C-reactive protein (CRP), B-type natriuretic peptide and homocysteine significantly were significantly decreased, while normal protein nitrogen appearance (nPNA) and albumin values were significantly increased after 18 months on PD. The carotid intima-media thickness (CIMT), left atrium diameter was significantly decreased (p<0.001) at the end of the study. Significant predictors of CIMT and CA diameter were residual renal function (RRF), albumin and CRP whereas significant predictors of presence of atherosclerotic plaques were RRF and CRP. Conclusion: We have found a close relationship between hemodynamic and structural CA changes with markers of poor nutrition, inflammation and hydration status in PD patients. The synergism of atherogenesis and monitored parameters, especially CA diameter and CIMT, seems to be useful in the management of PD patients and deserves further testing in properly designed clinical validation study.