Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, SAR, China.
Am J Nephrol. 2012;35(2):127-33. doi: 10.1159/000335580. Epub 2012 Jan 11.
Cardiovascular disease is the most common cause of mortality in chronic peritoneal dialysis (PD) patients. Increased arterial stiffness may be related to a high peritoneal permeability, resulting in fluid overload of PD patients. We examined the prognostic value and factors that govern the longitudinal change of arterial pulse wave velocity (PWV) in Chinese PD patients.
We enrolled 155 new PD patients. PWV was measured at baseline and then repeated after 2 years of follow-up.
At 24 months, the survival of patients with baseline carotid-femoral (CF)-PWV above 10 m/s was significantly worse than that of those with CF-PWV below 10 m/s (76.1 vs. 88.6%, p = 0.006). However, after adjusting for confounding factors, CF-PWV was not an independent predictor of survival. Amongst the 100 patients who had repeated PWV measurement after 2 years, the average CF-PWV increased from 9.92 ± 2.04 to 11.00 ± 2.30 m/s (p < 0.0001). The change in CF-PWV over 2 years significantly correlated with systolic blood pressure (r = 0.241, p = 0.036), serum calcium level (r = 0.231, p = 0.044), and normalized protein nitrogen appearance (NPNA) (r = -0.337, p = 0.001).
A high baseline CF-PWV was associated with a lower overall survival of Chinese PD patients, but the prognostic value of CF-PWV disappeared after adjusting for confounding factors. After 2 years of PD, most patients had progressive increase in CF-PWV; the magnitude of increase is related to systolic blood pressure, serum calcium level, and baseline NPNA. Further study is needed to determine whether serial measurement of CF-PWV provides additional prognostic information.
心血管疾病是慢性腹膜透析（PD）患者最常见的死亡原因。动脉僵硬度增加可能与较高的腹膜通透性有关，导致 PD 患者液体超负荷。我们研究了中国 PD 患者的动脉脉搏波速度（PWV）的预后价值和决定其纵向变化的因素。
我们纳入了 155 例新 PD 患者。在基线时测量 PWV，然后在 2 年的随访后重复测量。
在 24 个月时，基线颈动脉-股动脉（CF）-PWV 超过 10 m/s 的患者的生存率明显低于 CF-PWV 低于 10 m/s 的患者（76.1%比 88.6%，p=0.006）。然而，在调整混杂因素后，CF-PWV 不是生存的独立预测因素。在 100 例接受 2 年后重复 PWV 测量的患者中，平均 CF-PWV 从 9.92±2.04 增加到 11.00±2.30 m/s（p<0.0001）。2 年内 CF-PWV 的变化与收缩压（r=0.241，p=0.036）、血清钙水平（r=0.231，p=0.044）和校正蛋白氮表观（NPNA）（r=-0.337，p=0.001）显著相关。
基线时较高的 CF-PWV 与中国 PD 患者的总体生存率降低相关，但在调整混杂因素后，CF-PWV 的预后价值消失。在 PD 治疗 2 年后，大多数患者的 CF-PWV 逐渐增加；增加幅度与收缩压、血清钙水平和基线 NPNA 有关。需要进一步研究确定连续测量 CF-PWV 是否提供额外的预后信息。
