Plasma myeloperoxidase, NT‐proBNP, and troponin‐I in patients on CAPD compared with those on regular hemodialysis

Abstract

Myeloperoxidase (MPO) is a hemoprotein that is released during inflammation and may lead to irreversible protein and lipid modification, increasing levels of oxidized low density lipoprotein, and promoting athrogenesis. Recently, it has been considered as a risk factor for cardiovascular diseases. Similarly, the measurement of carotid intima-media thickness gives an indication about the degree of atherosclerosis and prediction of clinical cardiovascular events. Elevated white blood cells counts may indicate a state of acute inflammation and follow its progression. Dialysis patients are at a high risk of developing cardiovascular disease compared with healthy subjects. The role of N-terminal pro-brain natriuretic peptide and increased cardiac troponin in identification and prognostication of cardiovascular diseases in end-stage renal disease patients has been investigated. The current study aimed to evaluate plasma MPO and its possible relationship with carotid intima-media thickness, troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), and insulin resistance as measured by homeostatic model assessment (HOMA index) in a cohort of Saudi patients who are undergoing hemodialysis (HD) vs. continuous ambulatory peritoneal dialysis for end-stage renal disease. Plasma MPO was significantly higher in patients on continuous ambulatory peritoneal dialysis (CAPD) than in those on HD and in normal subjects (P<0.001). Conversely, NT-proBNP plasma levels were significantly higher in patients on HD (both predialysis and postdialysis) than in those on CAPD (P<0.01) and than normal subjects. Similarly, plasma troponin-I levels were significantly higher in patients on HD compared with those of CAPD and than normal subjects (P<0.001). Plasma troponin-I and NT-proBNP levels were positively correlated in the 3 groups namely those on CAPD, Pre-HD, and post-HD (r: 0.464 and P=0.047; r: 0.330 and P=0.013; and r: 0.452 and P=0.024), respectively. There was no correlation between the MPO level and carotid intima-media thickness (P>0.05). However, plasma MPO level correlated positively with the white blood cell count in patients on CAPD and in those on HD (P<0.05). Our findings suggest an increased oxidative stress in CAPD patients compared with HD patients, while the reported difference in plasma NT-proBNP and troponin-I may be related to the rapid decline of residual renal function in HD and type of membrane used in the HD dialysis procedure itself.

Comparison of NT-proBNP levels in hemodialysis versus peritoneal dialysis patients

“…Our results clearly show that patients on HD are more likely to have elevated levels of NT-proBNP compared to patients on CAPD, and this finding may suggest that from the cardiovascular stand point CAPD is a better alternative to HD for renal replacement therapy. These data are consistent with previously mentioned studies [27][28][29] . Whether an advantage predicted by a marker such as NT-proBNP leads to an actual morbidity or mortality benefit cannot be determined from the present study, and this clinically relevant hypothesis warrants further investigation.…”

“…The thought that such volume shifts would have adverse effect on the cardiovascular system have been postulated before, and there is an accumulating body of evidence suggesting that BNP and NT-proBNP levels are higher among patients on HD (ref. [27][28][29][30]. No previous studies to our knowledge assessed NT-proBNP according to the level of preservation of the left ventricular systolic function.…”

Serum Thiol/Disulfide Homeostasis in Hemodialysis, Peritoneal Dialysis, and Renal Transplantation Patients

“…The disulfide/native thiol levels were also different between the three groups; the disulfide/native thiol levels were slightly higher in the transplantation and PD groups compared to the HD group. While these results are consistent with few other previous studies, increased levels of oxidative stress in HD compared to those in PD have also been reported in some studies (20)(21)(22)(23)(24). We believe that the increased oxidative stress observed in the PD patients (compared to those in the HD patients) in our study may have been caused by inflammatory responses.…”

Oxidative Dna Damage and Mortality in Hemodialysis and Peritoneal Dialysis Patients

“…Also, it is not known whether oxidative stress varies with dialysis modality. In a few studies, increased levels of oxidative stress have been reported to be associated with hemodialysis (HD) compared with peritoneal dialysis (PD) (18,19), but other studies showed the opposite results (20)(21)(22).…”