Tang Wen, Cheng Li-Tao, Lu Xin-Hong, Wang Tao
Division of Nephrology, Peking University Third Hospital, Beijing, PR China.
Am J Nephrol. 2009;30(2):120-5. doi: 10.1159/000206697. Epub 2009 Feb 27.
A poor nutritional state is associated with an increased risk of cardiovascular events in end-stage renal disease. It is unclear whether malnutrition itself can induce cardiovascular disease (CVD). We examined the impact of nutritional status on patients' arterial stiffness in peritoneal dialysis (PD) patients.
We prospectively enrolled 121 stable PD patients and evaluated them at baseline and 1 year later. According to patients' Subjective Global Assessment (SGA) changes from baseline to the end, patients were divided into four groups: group 1, SGA from A to B; group 2, SGA remained A, group 3, SGA changed from B to A, and group 4, SGA remained B. Arterial stiffness was assessed by pulse-wave velocity (PWV).
At baseline, PWV in well-nourished patients were lower than malnourished patients (p < 0.05). One year later, in group 1, as compared with baseline, PWV increased significantly (p < 0.001) whereas handgrip strength (HGS), daily dietary protein intake and dietary energy intake decreased significantly. In group 3, PWV decreased significantly (p < 0.05) whereas HGS and ALB increased significantly. In groups 1 and 3, lgCRP level remained unchanged.
There was a closely longitudinal association between nutritional status and arterial stiffness in PD patients, suggesting a possible impact of nutritional status on arterial function.
营养不良状态与终末期肾病患者心血管事件风险增加相关。目前尚不清楚营养不良本身是否会诱发心血管疾病(CVD)。我们研究了营养状况对腹膜透析(PD)患者动脉僵硬度的影响。
我们前瞻性纳入了121例稳定的PD患者,并在基线和1年后对他们进行评估。根据患者从基线到终点的主观全面评定(SGA)变化,将患者分为四组:第1组,SGA从A变为B;第2组,SGA保持为A;第3组,SGA从B变为A;第4组,SGA保持为B。通过脉搏波速度(PWV)评估动脉僵硬度。
在基线时,营养良好患者的PWV低于营养不良患者(p<0.05)。1年后,在第1组中,与基线相比,PWV显著增加(p<0.001),而握力(HGS)、每日膳食蛋白质摄入量和膳食能量摄入量显著下降。在第3组中,PWV显著下降(p<0.05),而HGS和白蛋白(ALB)显著增加。在第1组和第3组中,lgCRP水平保持不变。
PD患者的营养状况与动脉僵硬度之间存在密切的纵向关联,提示营养状况可能对动脉功能有影响。