Comparison of atherosclerosis and atherosclerotic risk factors in patients receiving hemodialysis and peritoneal dialysis

Abstract

BACKGROUND: Although some studies have found that myocardial infarction and cerebrovascular disease are more common in patients receiving continuous ambulatory peritoneal dialysis (CAPD) than in patients receiving hemodialysis (HD), the results of other studies have not supported these findings. Studies comparing patients receiving HD with patients receiving CAPD have had conflicting results.OBJECTIVE: The aims of this study were to compare the atherosclerotic changes in CAPD and HD patients and to assess which factors might be responsible for atherosclerosis in dialysis patients.METHODS: Enrolled in the study were 33 patients receiving HD, 32 patients receiving CAPD, and 33 controls for a total of 98 participants. Serum triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein, lipoprotein (a) (Lp[a]), apolipoprotein A-I, apolipoprotein B (Apo B), apolipoprotein E (Apo E), albumin, high-sensitivity C-reactive protein (hs-CRP), fibrinogen, intact parathyroid hormone (iPTH), and ferritin levels were obtained from all patients. Carotid intima-media thickness (CIMT) and plaque number were calculated using B-mode ultrasonography.RESULTS: Serum TG, Lp(a), Apo B, hs-CRP, fibrinogen, ferritin, and iPTH levels were significantly higher in the dialysis groups than in the control group; whereas HDL, Apo E, and albumin levels were decreased (p Ͻ .05); the others were same in the all groups. However, there was no difference between the HD and CAPD groups in the other lipid parameters except Lp(a) (p Ͻ .05). CIMT and plaque number of the patients treated with dialysis were higher than those of the control group (p Ͻ .01), but were not significantly different between the 2 dialysis groups (p Ͼ .05). CIMT and plaque number were positively correlated with age (r ϭ 0.43; p Ͻ .05) and hs-CRP level (r ϭ 0.40; p Ͻ .05) and negative correlated with serum albumin and hs-CRP levels (r ϭ Ϫ0.37, p Ͻ .05; and r ϭ Ϫ0.25; p Ͻ .05, respectively).CONCLUSIONS: Serum Apo B and Lp(a) levels were higher in the CAPD patients than in the HD patients. CIMT and plaque number were positively correlated with age and hs-CRP level and negatively correlated with serum albumin and hs-CRP levels.

The Role of Dyslipidemia in Atherogenesis in Peritoneal Dialysis Patients

“…that changes in CCA are related to a disturbed lipid profile, primarily due to a reduced level of HDL and an increase in LDL. [ 32 ] We have confirmed that HDL represents a significant independent factor that influences the regression of CCA IMT in patients treated with CAPD, while LDL has a predictive influence on the rigidity of the CCA wall, assessed based on the CCA diameter. These results support the results of the Study of Heart and Renal Protection (SHARP) study[ 33 ] that lipid disorders should be aggressively treated in dialysis patients in order to reduce the risk of CVD and keep the LDL level below 3 mmol/L.…”

Peritoneal Dialysis Is an Independent Factor Associated to Lower Intima Media Thickness in Dialysis Patients Free From Previous Cardiovascular Disease

“…Currently, studies about dialysis impact on ultrasound measured cIMT have shown contradictory results. Despite all studies have found higher cIMT on dialysis patients than in non-dialysis population,(Cengiz and Dolu, 2007; Mutluay et al, 2012; Shi et al, 2012) some of them reported higher cIMT in PD than in HD (Ozdemir et al, 2001; Shi et al, 2012), some other did not find significant differences on cIMT between dialysis type (Cengiz and Dolu, 2007; Yilmaz et al, 2007; Al-Hweish et al, 2010), and some others reported increased cIMT in HD patients (Mutluay et al, 2012). However, it is important to remark that, in contrast to most previous studies, the NEFRONA study excluded patients with a previous CVE.…”