Carotid intimal thickness and flow-mediated dilatation in diabetic and nondiabetic continuous ambulatory peritoneal
Narayan Prasad1, Sudeep Kumar, Anurag Singh
1Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. narayan@sgpgi.ac.in
Insights
End-stage renal disease patients on peritoneal dialysis show increased atherosclerosis markers like carotid intima media thickness (CIMT) and reduced flow-mediated dilatation (FMD) compared to controls. Serum inorganic phosphate is a key risk factor for atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Diagnostic Imaging
Background:
- End-stage renal disease (ESRD) is associated with accelerated atherosclerosis.
- Peritoneal dialysis (PD) is a common treatment for ESRD, but its impact on atherosclerosis markers requires further investigation.
- Identifying risk factors for atherosclerosis in ESRD patients is crucial for clinical management.
Purpose of the Study:
- To compare carotid intima media thickness (CIMT) and flow-mediated dilatation (FMD) between ESRD patients on PD and controls with normal renal function.
- To identify risk factors predicting atherosclerosis in ESRD patients undergoing PD.
Main Methods:
- A cross-sectional study involving 124 subjects (62 cases on PD, 62 controls).
- B-mode ultrasonography was used to measure CIMT and endothelium-dependent FMD.
- Pearson correlation analysis was performed to assess the relationship between CIMT and other variables.
Main Results:
- ESRD patients on PD exhibited significantly higher CIMT and lower FMD compared to controls.
- Cases had elevated levels of systolic blood pressure, lipids, uric acid, inorganic phosphate, C-reactive protein, and parathyroid hormone.
- Diabetic ESRD patients on PD showed higher CIMT than non-diabetic patients, while FMD was similar between these groups.
Conclusions:
- ESRD patients on PD have significantly higher CIMT and lower FMD, indicating increased atherosclerosis and endothelial dysfunction.
- Serum inorganic phosphate is identified as an independent risk factor for atherosclerosis, strongly correlated with CIMT.
- Noninvasive CIMT and FMD tests are valuable tools for monitoring atherosclerosis and endothelial dysfunction in this population.
Objectives:
We compared carotid intima media thickness (CIMT) and flow-mediated dilatation (FMD) between cases [end-stage renal disease patients (diabetic and nondiabetic) on peritoneal dialysis (PD)] and controls (diabetic and hypertensive patients with normal renal function) with the objective of identifying risk factors predicting atherosclerosis.
Methods:
This cross-sectional study involved 124 subjects (62 cases, 62 controls). In both the case and control populations, we used B-mode ultrasonography to study CIMT and endothelium-dependent FMD, according to American College of Cardiology guidelines on brachial artery measurement. Pearson correlation was used to evaluate the correlation between CIMT and other variables.
Results:
Compared with controls, cases had significantly higher systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, triglycerides, serum uric acid, inorganic phosphate, C-reactive protein, and parathyroid hormone, and significantly lower hemoglobin, calcium, and high-density lipoprotein. Compared with controls, cases showed significantly greater CIMT (0.60 +/- 0.08 mm vs 0.54 +/- 0.03 mm, p < 0.001) and significantly lower FMD (0.15 +/- 0.08 cm vs 0.21 +/- 0.04 cm, p = 0.02). Among cases, patients with diabetes had significantly greater CIMT (0.62 +/- 0.08 mm vs 0.58 +/- 0.07 mm, p = 0.05) than did patients without diabetes; FMD was similar in diabetic and nondiabetic patients on continuous ambulatory PD (0.16 +/- 0.03 cm vs 0.18 +/- 0.03 cm, p = 0.20).
Conclusions:
Compared with controls, cases had significantly higher CIMT and lower FMD. Cases with diabetes had significantly higher CIMT than did cases without diabetes, but FMD was similar in diabetic and nondiabetic cases. Serum inorganic phosphate is an independent risk factor for atherosclerosis and was significantly correlated with CIMT. The noninvasive CIMT and FMD tests can be used to monitor atherosclerosis and endothelial dysfunction.
