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Endothelial dysfunction is associated with major adverse cardiovascular events in peritoneal dialysis patients.

Lee MJ, Han SH, Lee JE, Choi HY, Yoon CY, Kim EJ, Han JH, Han JS, Oh HJ, Park JT, Kang SW, Yoo TH - Medicine (Baltimore) (2014)

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine (MJL, SHH, JEL, HYC, C-YY, EJK, JHH, JSH, HJO, JTP, S-WK, T-HY); and Severance Biomedical Science Institute, Brain Korea 21 PLUS (S-WK, T-HY), Yonsei University College of Medicine, Seoul, Korea.

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.

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Related in: MedlinePlus

Endothelial function in PD patients and controls. Box plot of brachial artery FMD (A) and NMD (B) values in PD patients and controls. Boxes represent the interquartile range and the lines denote the median. Error bars are 95% confidence intervals. C = controls, FMD = flow-mediated dilation, NMD = nitroglycerin-mediated dilation, PD = peritoneal dialysis.
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Figure 2: Endothelial function in PD patients and controls. Box plot of brachial artery FMD (A) and NMD (B) values in PD patients and controls. Boxes represent the interquartile range and the lines denote the median. Error bars are 95% confidence intervals. C = controls, FMD = flow-mediated dilation, NMD = nitroglycerin-mediated dilation, PD = peritoneal dialysis.

Mentions: Baseline characteristics of the 143 patients on PD and 32 controls are shown in Table 1. The mean age was 47.2 ± 7.5 years in controls and 49.5 ± 11.2 years in PD patients. Fourteen patients (43.8%) were men among controls and 69 patients (48.3%) were men among PD patients. No significant differences between PD patients and controls were observed in age, sex, the proportion of smokers, diastolic blood pressure, or BMI. Compared with the control participants, PD patients showed significantly lower FMD (PD vs control, 2.9% [1.3–4.7] vs 6.2% [5.4–8.3], P < 0.001), whereas NMD was not different between the 2 groups (11.3% [9.3–14.6] vs 13.1% [11.7–14.2], P = 0.44) (Figure 2).


Endothelial dysfunction is associated with major adverse cardiovascular events in peritoneal dialysis patients.

Lee MJ, Han SH, Lee JE, Choi HY, Yoon CY, Kim EJ, Han JH, Han JS, Oh HJ, Park JT, Kang SW, Yoo TH - Medicine (Baltimore) (2014)

Endothelial function in PD patients and controls. Box plot of brachial artery FMD (A) and NMD (B) values in PD patients and controls. Boxes represent the interquartile range and the lines denote the median. Error bars are 95% confidence intervals. C = controls, FMD = flow-mediated dilation, NMD = nitroglycerin-mediated dilation, PD = peritoneal dialysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4616272&req=5

Figure 2: Endothelial function in PD patients and controls. Box plot of brachial artery FMD (A) and NMD (B) values in PD patients and controls. Boxes represent the interquartile range and the lines denote the median. Error bars are 95% confidence intervals. C = controls, FMD = flow-mediated dilation, NMD = nitroglycerin-mediated dilation, PD = peritoneal dialysis.
Mentions: Baseline characteristics of the 143 patients on PD and 32 controls are shown in Table 1. The mean age was 47.2 ± 7.5 years in controls and 49.5 ± 11.2 years in PD patients. Fourteen patients (43.8%) were men among controls and 69 patients (48.3%) were men among PD patients. No significant differences between PD patients and controls were observed in age, sex, the proportion of smokers, diastolic blood pressure, or BMI. Compared with the control participants, PD patients showed significantly lower FMD (PD vs control, 2.9% [1.3–4.7] vs 6.2% [5.4–8.3], P < 0.001), whereas NMD was not different between the 2 groups (11.3% [9.3–14.6] vs 13.1% [11.7–14.2], P = 0.44) (Figure 2).

Bottom Line: 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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine (MJL, SHH, JEL, HYC, C-YY, EJK, JHH, JSH, HJO, JTP, S-WK, T-HY); and Severance Biomedical Science Institute, Brain Korea 21 PLUS (S-WK, T-HY), Yonsei University College of Medicine, Seoul, Korea.

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.

Show MeSH
Related in: MedlinePlus