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Endothelial Dysfunction Is Associated With Major Adverse Cardiovascular Events in Peritoneal Dialysis Patients

Authors
 Mi Jung Lee  ;  Seung Hyeok Han  ;  Jung Eun Lee  ;  Hoon Young Choi  ;  Chang-Yun Yoon  ;  Eun Jin Kim  ;  Jae Hyun Han  ;  Ji Suk Han  ;  Hyung Jung Oh  ;  Jung Tak Park  ;  Shin-Wook Kang  ;  Tae-Hyun Yoo 
Citation
 MEDICINE, Vol.93(11) : 73, 2014 
Journal Title
 MEDICINE 
ISSN
 0025-7974 
Issue Date
2014
MeSH
Adult ; Age Factors ; Body Mass Index ; Brachial Artery/physiopathology ; Cardiovascular Diseases/diagnosis* ; Cardiovascular Diseases/physiopathology ; Endothelium, Vascular/physiopathology* ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Peritoneal Dialysis/statistics & numerical data* ; Predictive Value of Tests ; Prospective Studies ; Risk Factors ; Sex Factors ; Vasodilation/physiology
Abstract
Endothelial dysfunction is implicated in increased cardiovascular risk in nondialyzed population. However, the prognostic impact of endothelial dysfunction on cardiovascular outcome has not been investigated in peritoneal dialysis (PD) patients. We prospectively determined endothelial function by brachial artery endothelium-dependent vasodilation (flow-mediated dilation [FMD]) in 143 nondiabetic PD patients and 32 controls. Primary outcome was a major adverse cardiac and cerebrovascular event (MACCE). Brachial FMD was significantly lower in PD patients than in controls (2.9% [1.3-4.7] vs 6.2% [5.4-8.3], P < 0.001). During a mean follow-up of 42 months, primary outcome was observed in 25 patients (17.5%). When patients were dichotomized by the median value of FMD (2.9%), incidence rates of MACCEs were significantly higher in the group with lower FMD compared with higher FMD (7.2 vs 3.0/100 person-years, P = 0.03). In multivariate Cox analysis, low FMD (≤2.9%) was a significant independent predictor of MACCEs (hazard ratio = 2.73, 95% confidence interval = 1.03-7.22, P = 0.04). Furthermore, multivariate fractional polynomial analysis showed that the risk of MACCE decreased steadily with higher FMD values. Impaired brachial FMD was a significant independent predictor of MACCEs in PD patients. Estimating endothelial dysfunction by brachial FMD could be useful for stratifying cardiovascular risk in these patients.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00005792-201409010-00004&LSLINK=80&D=ovft
DOI
10.1097/MD.0000000000000073
Appears in Collections:
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, Eun Jin(김은진)
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Oh, Hyung Jung(오형중)
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Yoon, Chang Yun(윤창연)
Lee, Mi Jung(이미정)
Lee, Jung Eun(이정은) ORCID logo https://orcid.org/0000-0003-0917-2872
Choi, Hoon Young(최훈영) ORCID logo https://orcid.org/0000-0002-4245-0339
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
Han, Jae Hyun(한재현)
Hahn, Jee Sook(한지숙)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99543
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