지속성 외래 복막투석 환자에서 혈관내피세포 기능이상에 대한 영양상태 및 만성 염증의 영향

Abstract

Background: Cardiovascular mortality is increased in ESRD patients and is not completely explained by common cardiovascular risk factors. Therefore, more attention is being focused on non-traditional risk factors such as endothelial dysfunction, malnutrition, chronic inflammation. This study was performed to investigate whether chronic inflammation and malnutrition plays an important role on the endothelial dysfunction in ESRD patients.

Methods: Seventy-five patients undergoing CAPD for more than six months were enrolled in the study. To evaluate the extent of endothelial dysfunction, flow-mediated vasodilation (FMD) of brachial artery was measured using doppler ultrasonography. The degree of chronic inflammation was assessed by measuring inflammatory markers (IL-6, hsCRP) and SGA was used to assess the nutritional status.

Results: According to SGA grade, the patients were divided into 2 groups (group 1:normal nutritional status, group 2:malnourished status). In group 2, IL-6 was significantly higher compared to group 1. FMD and albumin level were significantly lower in group 2 (11.37±4.93 vs. 8.41±4.23%, 3.7±0.4 vs. 3.4±0.3 g/dL, p<0.05). When the patients were divided into groups according to hsCRP level (group 1:≥3 mg/L, group 2:<3 mg/L), BMI and fasting glucose were significantly higher in group 1 compared to group 2 (25.9±3.5 vs. 23.9±2.8 kg/㎡, 105.8±22.3 vs. 93.3±11.4 mg/dL). HDL-cholesterol was significantly lower in group 1 (37.4±9.3 vs. 45.3±12.9 mg/dL). FMD was decreased in group 1 compared to group 2 (7.35±4.23 vs. 11.57±4.76%). Multiple regression analysis showed that average hsCRP concentration was an independent factors affecting brachial FMD.

Conclusion: These findings suggest that endothelial dysfunction is associated with markers of inflammation and malnutrition, and chronic inflammation and malnutrition can be a predisposing factors for atherosclerosis in CAPD patients.