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Association of inflammation and protein-energy wasting with endothelial dysfunction in peritoneal dialysis patients

 Hoon Young Choi  ;  Jung Eun Lee  ;  Seung Hyeok Han  ;  Tae Hyun Yoo  ;  Beom Seok Kim  ;  Hyeong Cheon Park  ;  Shin-Wook Kang  ;  Kyu Hun Choi  ;  Sung Kyu Ha  ;  Ho Yung Lee  ;  Dae-Suk Han 
Journal Title
Issue Date
Cross-Sectional Studies ; Endothelium, Vascular/pathology* ; Female ; Humans ; Inflammation/etiology* ; Male ; Middle Aged ; Peritoneal Dialysis/adverse effects* ; Protein-Energy Malnutrition/etiology* ; Treatment Outcome ; Vasodilation/drug effects
BACKGROUND: Cardiovascular disease is the main cause of mortality in end-stage renal disease (ESRD) patients. Recent studies have indicated that non-traditional risk factors such as endothelial dysfunction (ED), chronic inflammation and protein-energy wasting (PEW) may contribute significantly to the increased cardiovascular mortality among dialysis patients. To further ascertain this association, we carried out a cross-sectional assessment of nutritional status, inflammatory markers and endothelial dysfunction in peritoneal dialysis (PD) patients.

METHODS: We measured ED functionally by flow-mediated vasodilatation (FMD) using doppler ultrasonography and biochemically by soluble intercellular adhesion molecule-1 (sICAM-1) in 105 stable PD patients and 32 age- and sex-matched healthy controls. We also simultaneously measured inflammatory markers and performed a subjective global assessment (SGA) of their nutritional status using a seven-point scoring scale. Subjects were subgrouped according to their nutritional and inflammatory status.

RESULTS: In PD patients, FMD was markedly lower (9.9 +/- 4.8% vs. 16.4 +/- 4.8%, P < 0.05), and sICAM-1 was significantly higher than those in controls. The malnourished patients had significantly lower FMD (8.4+/-4.6% vs. 10.8+/-4.7%, P <0.05) and higher sICAM-1 than the nourished patients. The inflamed group had significantly lower FMD (7.1 +/- 3.8 vs.11.1 +/- 4.6%, P < 0.05) and higher sICAM-1 than the non-inflamed group. In all PD patients, lean body mass/body weight %, albumin and SGA correlated positively with FMD (r = +0.207, r = +0.224, r = +0.285, P < 0.05). However, age, log high sensitivity C-reactive protein (hsCRP), log IL-6 and sICAM-1 were negatively correlated with FMD (r = -0.275, r = -0.361, r = -0.360, r = -0.271, P < 0.05). A multiple regression analysis showed that log hsCRP was an independent factor affecting FMD. Endothelial function, demonstrated as FMD and sICAM-1 in the nourished PD patients without inflammation, was well preserved compared to other subgroups.

CONCLUSION: Our data suggest that chronic inflammation and PEW are closely linked to ED in PD patients
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Park, Hyeong Cheon(박형천) ORCID logo https://orcid.org/0000-0002-1550-0812
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Jung Eun(이정은) ORCID logo https://orcid.org/0000-0003-0917-2872
Lee, Ho Yung(이호영)
Choi, Kyu Hun(최규헌) ORCID logo https://orcid.org/0000-0003-0095-9011
Ha, Sung Kyu(하성규)
Han, Dae Suk(한대석)
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