Carotid intimal thickness and flow-mediated dilatation in diabetic and nondiabetic continuous ambulatory peritoneal dialysis patients.
OBJECTIVE
We compared carotid intima media thickness (CIMT) and flow-mediated dilatation (FMD) between cases [end-stage renal disease patients (diabetic and nondiabetic) on peritoneal dialysis (PD)] and controls (diabetic and hypertensive patients with normal renal function) with the objective of identifying risk factors predicting atherosclerosis.


METHODS
This cross-sectional study involved 124 subjects (62 cases, 62 controls). In both the case and control populations, we used B-mode ultrasonography to study CIMT and endothelium-dependent FMD, according to American College of Cardiology guidelines on brachial artery measurement. Pearson correlation was used to evaluate the correlation between CIMT and other variables.


RESULTS
Compared with controls, cases had significantly higher systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, triglycerides, serum uric acid, inorganic phosphate, C-reactive protein, and parathyroid hormone, and significantly lower hemoglobin, calcium, and high-density lipoprotein. Compared with controls, cases showed significantly greater CIMT (0.60 +/- 0.08 mm vs 0.54 +/- 0.03 mm, p < 0.001) and significantly lower FMD (0.15 +/- 0.08 cm vs 0.21 +/- 0.04 cm, p = 0.02). Among cases, patients with diabetes had significantly greater CIMT (0.62 +/- 0.08 mm vs 0.58 +/- 0.07 mm, p = 0.05) than did patients without diabetes; FMD was similar in diabetic and nondiabetic patients on continuous ambulatory PD (0.16 +/- 0.03 cm vs 0.18 +/- 0.03 cm, p = 0.20).


CONCLUSIONS
Compared with controls, cases had significantly higher CIMT and lower FMD. Cases with diabetes had significantly higher CIMT than did cases without diabetes, but FMD was similar in diabetic and nondiabetic cases. Serum inorganic phosphate is an independent risk factor for atherosclerosis and was significantly correlated with CIMT. The noninvasive CIMT and FMD tests can be used to monitor atherosclerosis and endothelial dysfunction.
Prasad
Narayan
N
Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. narayan@sgpgi.ac.in
Kumar
Sudeep
S
Singh
Anurag
A
Sinha
Archana
A
Chawla
Kamal
K
Gupta
Amit
A
Sharma
R K
RK
Sinha
Nakul
N
Kapoor
Aditya
A
D001783:Blood Flow Velocity / Q000502:physiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014463:Ultrasonography; D014664:Vasodilation / Q000502:physiology*