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

作者：Choi Hoon Young; Lee Jung Eun; Han Seung Hyeok; Yoo Tae Hyun; Kim Beom Seok; Park Hyeong Cheon; Kang Shin Wook; Choi Kyu Hun; Ha Sung Kyu; Lee Ho Yung; Han Dae Suk^*

来源：Nephrology Dialysis Transplantation, 2010, 25(4): 1266-1271.

DOI：10.1093/ndt/gfp598

• endothelial dysfunction
• inflammation
• peritoneal dialysis
• protein-energy wasting

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 dysED), 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-I 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 FM D. Endothelial function, demonstrated as FMD and sICAM-1 in the nourished PD patients with-out 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.

• 出版日期2010-4