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Comparison of carotid intima-media thickness between hemodialysis and peritoneal dialysis patients
Nur Samsu1, Mala Hayati2, Eden Suryoiman Winoto3
1Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang 65145, Jawa Timur, Indonesia. nur_samsu.fk@ub.ac.id.
Insights
Peritoneal dialysis (PD) patients exhibit lower carotid intima-media thickness (cIMT) than hemodialysis (HD) patients, indicating reduced cardiovascular risk. Klotho may play a role in this protective effect by stabilizing atherosclerotic plaques.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Patients with chronic kidney disease (CKD) face elevated cardiovascular disease (CVD) risks.
- Carotid intima-media thickness (cIMT) is a key indicator of CVD risk.
- Klotho is linked to improved atherosclerotic plaque stability in CKD patients.
Purpose of the Study:
- To examine the relationship between dialysis modality and cIMT in dialysis patients.
- To compare cIMT levels between hemodialysis (HD) and peritoneal dialysis (PD) patients.
- To explore the role of FGF-23 and Klotho in dialysis-related atherosclerosis.
Main Methods:
- A cross-sectional study involving 83 dialysis patients (40 HD, 43 PD).
- Data collection included patient history, carotid artery ultrasonography for cIMT, and laboratory tests.
- cIMT was measured across six carotid artery segments.
Main Results:
- PD patients demonstrated significantly lower cIMT compared to HD patients (P = 0.005).
- Younger age was independently associated with lower cIMT in PD patients (P = 0.003).
- PD patients had a lower FGF23/Klotho ratio than HD patients (P = 0.039).
- In PD patients, calcium, phosphorus, and CaxP product correlated positively with FGF-23, but this correlation weakened with the FGF-23/Klotho ratio.
Conclusions:
- Peritoneal dialysis is associated with lower cIMT than hemodialysis.
- Younger age is a significant factor in reduced cIMT.
- Klotho appears to mitigate the positive correlation between CaxP product and FGF-23/Klotho ratio, potentially contributing to lower cIMT in PD patients.
Background:
Patients with chronic kidney disease (CKD) are at high risk of developing cardiovascular disease (CVD). Carotid intima-media thickness (cIMT) is a strong predictor of CVD. Klotho has been associated with increased atherosclerotic plaque stability in CKD patients.
Aim:
To investigate the association between dialysis modality and cIMT in dialysis patients.
Methods:
A cross-sectional study of 83 dialysis patients, 40 hemodialysis (HD) patients and 43 peritoneal dialysis (PD) patients, who met the inclusion criteria. Anamnesis, carotid artery ultrasonography (USG), and laboratory tests were performed on all patients. cIMT measurements were performed in 6 carotid territories using arterial USG.
Results:
PD patients had lower cIMT [0.53 (0.47; 0.67) vs 0.63 (0.54; 0.70); P = 0.005]. Younger age in PD patients was independently associated with lower cIMT (β = 0.006; P = 0.003). PD patients had a lower FGF23/Klotho ratio compared to HD patients [26.26 (13.32; 69.45) vs 67.34 (16.56; 131.35); P = 0.039]. Similarly, in PD patients, a moderate positive correlation was found between calcium, phosphorus, and CaxP product levels with fibroblast growth factor 23 (FGF-23) levels. However, the strength of the correlation was reduced when correlated with the FGF-23/Klotho ratio.
Conclusion:
This study showed that PD patients have lower cIMT than HD patients. Younger age was independently associated with lower cIMT. On the other hand, FGF-23 and the FGF-23/Klotho ratio were significantly positively correlated with CaxP product in PD patients, but not in HD patients. Klotho reduces the strength of this correlation, thus appearing play an important role in the lower cIMT in these PD patients.
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