Comparison of markers of oxidative stress, inflammation and arterial stiffness between incident hemodialysis and peritoneal dialysis patients – an observational study

Abstract

BackgroundPatients on peritoneal and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. The atherosclerosis is associated with increased arterial stiffness, endothelial dysfunction and elevated oxidative stress and inflammation. The aims of this study are to investigate the effects of peritoneal and hemodialysis on arterial stiffness, vascular function, myocardial structure and function, oxidative stress and inflammation in incident patients with end stage kidney disease.MethodsThis is an observational study. Eighty stage five CKD patients will be enrolled and followed for one-year. Primary outcome measures will be changes in 1) arterial stiffness measured by aortic pulse wave velocity, 2) oxidative stress assessed by plasma F2 isoprostanes and 3) inflammation measured by plasma pentraxin-3. Secondary outcomes will include additional measures of oxidative stress and inflammation, changes in vascular function assessed using the brachial artery reactivity technique, carotid artery intimal medial thickness, augmentation index and trans thoracic echocardiography to assess left ventricular geometry, and systolic and diastolic function. Patients will undergo these measures at baseline (6–8 weeks prior to starting dialysis therapy), then at six and 12 months after starting dialysis.DiscussionThe results of this study may guide the choice of dialysis modality in the first year of treatment. It may also lead to a larger study prospectively assessing the effect of dialysis modality on cardiovascular morbidity and mortality.Trial RegistrationACTRN12609000049279

Reproducibility of regional pulse‐wave velocity in uremic subjects

“…Obtain an optimal quality of measured waves is the basic condition for a correct PWV analysis. As already demonstrated by Covic et al 28 in 48 predialysis, 20 dialysis, and 18 transplant patients, and Fassett et al 29 in 144 patients with acute kidney injury, site is indifferent for the results.…”

Association of insulin resistance with arterial stiffness in nondiabetic peritoneal dialysis patients

“…Dialysis patients have increased AS compared to the general population and ESRD is considered as a risk factor for AS [23]. It has been suggested that older age, high blood pressure, vascular calcification, fluid overload, inflammation, increased sympathetic activity, activation of the renin-angiotensin system, increased low density lipoprotein (LDL) oxidation, and abnormalities of the nitric oxide system may play a role in arterial wall dysfunction, eventually leading to an increase in arterial stiffness [24][25][26][27]. IR has been shown to be correlated with AS in several populations including type 2 diabetes patients, obese subjects and postmenopausal women [28][29][30].…”

Inflammation in Peritoneal Dialysis

“…While initiation of hemodialysis may partially reduce C-reactive protein (CRP) levels, this was not observed during PD initiation, suggesting different effects of individual dialysis techniques on the inflammatory outcome [4]. Regardless of the differences in techniques, inflammation in PD patients is associated with a poor prognosis, with accelerated atherosclerosis, and an increase in cardiovascular morbidity and mortality [5]. The atherosclerosis is associated with increased arterial stiffness, endothelial dysfunction and elevated oxidative stress and inflammation.…”