당뇨 혈액투석 환자에서 혈관내피세포 기능이상에 영향을 미치는 인자

Abstract

BACKGROUND: Non-traditional risk factors of cardiovascular disease such as endothelial dysfunction, inflammation and malnutrition may be significant contributors to the excessive cardiovascular mortality in end stage renal disease (ESRD) patients. This study was undertaken to evaluate endothelial function in diabetic ESRD patients on hemodialysis and correlation between endothelial dysfunction and clinical, biochemical parameters. METHODS: Twenty eight stable diabetic ESRD patients (M: F=1.3: 1, average age: 60.1+/-1.0 yr) on hemodialysis were included. flow-mediated dilation (FMD) of brachial artery was measured using Doppler ultrasonography with 10 MHz transducer. Subjective global assessment (SGA) was used to assess the nutritional status of patients. RESULTS: The FMD (%) (% change of brachial artery diameter between before and after cuff inflation) was 5.1+/-1.0%. Serum albumin and C-reactive protein (CRP) were independent factors influencing SGA. When the patients were divided into groups according to history of ischemic heart disease (IHD), systolic pressure was significantly higher and FMD (%) was significantly lower in the group of patients with IHD compared with the group of patients without IHD. The FMD (%) showed significant positive correlation with SGA, serum albumin, and significant negative correlation with CRP. On multiple regression analysis, however, only CRP was an independent factor affecting FMD (%). CONCLUSION: These findings suggest that CRP influenced the nutritional status of diabetic ESRD patients on hemodialysis, and endothelial dysfunction, estimated by FMD, was significantly correlated with CRP. Therefore, CRP can be a modifiable risk factor for endothelial dysfunction in diabetic ESRD patients on hemodialysis.