Yang L, Lin Y, Ye C, Mao Z, Rong S, Zhao X, Mei C
Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Clin Nephrol. 2011 Mar;75(3):188-94. doi: 10.5414/cnp75188.
Arterial stiffness is one of the major complications in chronic kidney disease. In this study, we investigated the association between glomerular filtration rate (GFR) and arterial stiffness in chronic kidney disease (CKD), and studied the effect of dialysis on arterial stiffness.
A total of 62 stable continuous ambulatory peritoneal dialysis (CAPD) patients, 56 patients on maintenance hemodialysis, 128 predialysis CKD patients and 40 healthy controls were included into this study. These four groups were all nondiabetic and comparable in age and gender. The pulse wave velocity (PWV) and augmentation index (AIx) were evaluated by an applanation tonometry (SphygmoCor). Clinical data and lab tests were collected from inpatient case history and dialysis data base.
Female patients had higher AIx than male patients in both predialysis and dialysis patients. Both PWV and AIx were positively correlated with age, and were significantly higher in patients requiring antihypertensive drugs (p < 0.05). PWV and AIx were negatively correlated with GFR in predialysis CKD patients (p < 0.05). Patients on peritoneal dialysis or hemodialysis had better PWV and AIx than predialysis CKD 5 patients (19.8 ± 10.9%, 19.7 ± 9.4% vs. 25.3 ± 10.1%, p < 0.05), indicating that dialysis may improve arterial stiffness. No difference was found between peritoneal dialysis and hemodialysis patients.
This study demonstrates that arterial stiffness progresses with deterioration of renal function in CKD patients, and both peritoneal dialysis and hemodialysis can improve arterial stiffness in patients with uremia.
动脉僵硬度是慢性肾脏病的主要并发症之一。在本研究中，我们调查了慢性肾脏病（CKD）患者肾小球滤过率（GFR）与动脉僵硬度之间的关联，并研究了透析对动脉僵硬度的影响。
本研究纳入了62例稳定的持续性非卧床腹膜透析（CAPD）患者、56例维持性血液透析患者、128例透析前CKD患者和40例健康对照者。这四组均为非糖尿病患者，年龄和性别具有可比性。采用压平式眼压计（SphygmoCor）评估脉搏波速度（PWV）和增强指数（AIx）。从住院病历和透析数据库中收集临床资料和实验室检查结果。
透析前和透析患者中，女性患者的AIx均高于男性患者。PWV和AIx均与年龄呈正相关，在需要使用降压药物的患者中显著更高（p<0.05）。透析前CKD患者的PWV和AIx与GFR呈负相关（p<0.05）。腹膜透析或血液透析患者的PWV和AIx优于透析前CKD患者（19.8±10.9%，19.7±9.4%对25.3±10.1%，p<0.05），表明透析可能改善动脉僵硬度。腹膜透析和血液透析患者之间未发现差异。
本研究表明，CKD患者的动脉僵硬度随肾功能恶化而进展，腹膜透析和血液透析均可改善尿毒症患者的动脉僵硬度。
