Differential associations of traditional and non-traditional risk factors with carotid intima-media thickening and plaque in peritoneal dialysis patients.
BACKGROUND
This study sought to examine the associations of traditional and non-traditional cardiovascular risk factors with carotid intima-media thickening and plaque in peritoneal dialysis (PD) patients.


METHODS
A cross-sectional study was performed in 147 PD patients with carotid intima-media thickness (IMT) and plaque assessed by B-mode ultrasonography and fasting blood collected for biochemical measurements.


RESULTS
On univariate analysis, age, smoking history, fibrinogen, C-reactive protein (CRP), adiponectin, fetuin-A, lipoprotein(a) and diastolic blood pressure were associated with carotid IMT while age, smoking history, diabetes, CRP and diastolic blood pressure were associated with carotid plaque. Using multivariate analysis, elevated CRP (p = 0.015) and serum calcium (p = 0.022) were associated with carotid plaque but not with IMT. CRP and serum calcium were synergistically associated with carotid plaque in that those with CRP > median and serum calcium > median showed the highest prevalence of carotid plaque than either factor alone (p = 0.003).


CONCLUSIONS
An elevated CRP appeared to be a better biomarker of presence of carotid plaque than intima-media thickening. Furthermore, CRP and serum calcium showed synergistic association with presence of carotid plaque. However, our study was limited by the cross-sectional design and baseline laboratory abnormalities were inevitably confounded by the treatment already given, resulting in difficulty to distinguish cause and effect relationship. Nevertheless, these observations warrant further investigation as it may potentially have important implications on differentiating therapeutic strategies for reducing carotid IMT and plaque progression in PD patients.
Wang
Angela Yee-Moon
AY
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, SAR, China. aymwang@hku.hk
Ho
Stella Sin-Yee
SS
Liu
Eric Kin-Hung
EK
Chan
Iris Hiu-Shuen
IH
Ho
Simon
S
Sanderson
John E
JE
Lam
Christopher Wai-Kei
CW
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002118:Calcium / Q000097:blood; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D015995:Prevalence; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014463:Ultrasonography
D015415:Biomarkers; D002097:C-Reactive Protein; D002118:Calcium