Department of Internal Medicine, Division of Nephrology, Faculty of Health Sciences, University of Witwatersrand, 7, York Street, Parktown, Johannesburg, South Africa.
Department of Internal Medicine, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun-State, Nigeria.
BMC Nephrol. 2019 Oct 30;20(1):399. doi: 10.1186/s12882-019-1583-8.
Occurrence of cardiovascular disease (CVD) in the setting of chronic kidney disease (CKD) can be described as a "cruel alliance", with CVD responsible for about half of all deaths among CKD patients. Chronic kidney disease patients are more likely to die from CVD than progress to end stage kidney disease (ESKD). Dyslipidaemia, a known traditional risk factor for CVD, is highly prevalent among CKD patients and with an even higher frequency among ESKD patients on dialytic therapies. Prolonged exposure of continuous ambulatory peritoneal dialysis (CAPD) patients to high glucose concentrations in CAPD fluid have been associated with increased risk of cardiovascular events. In this study, we investigated the relationship of atherosclerotic vascular disease (AsVD) to clinical and echocardiographic parameters among black South Africans with CKD (stage 3) and ESKD on CAPD and haemodialysis (HD).
This was a cross-sectional study of 40 adult (18-65 years) non-diabetic CKD patients (kidney disease outcome quality initiative [KDOQI] stage 3), 40 ESKD patients on CAPD, 40 ESKD patients on HD and 41 age and sex-matched healthy controls. An interviewer-administered questionnaire was used to obtain information on participants' sociodemographic and cardiovascular risk factors. Anthropometric parameters were measured. Serum blood samples were analysed for creatinine, albumin and lipid profile; lipoprotein ratios, Framingham's risk score and the 10-year risk of developing coronary heart disease (CHD) were calculated. Echocardiography was performed on all patients and carotid intima media thickness (CIMT) was measured in both right and left carotid arteries at 1 cm proximal to the carotid bulb. Spearman's rank correlation and binary logistic regression were conducted to determine the relationship of AsVD to clinical and echocardiographic parameters.
Atherosclerotic vascular disease was most prevalent among ESKD patients on CAPD (70%, n = 28/40). Chronic kidney disease and HD patients exhibited a similar prevalence (47.5%, n = 19/40), while the prevalence in controls was 17.1% (n = 7/41). Presence of AsVD was associated with significantly older age, higher waist hip ratio (WHR), left ventricular mass index (LVMI) and Framingham's 10-year risk of developing CHD. Significant differences in clinical and echocardiographic parameters were observed when the study groups were compared. Age and LVH independently predicted AsVD.
Atherosclerotic vascular disease was more prevalent among CAPD patients compared to pre-dialysis CKD and HD patients. Among all lipoprotein ratios assessed, non-HDL-C showed the most consistent significant difference between the groups. Age (> 40 years) and presence of LVH were independent predictors of AsVD.
慢性肾脏病（CKD）患者心血管疾病（CVD）的发生可以被描述为“残酷的联盟”，因为 CVD 导致了大约一半的 CKD 患者死亡。CKD 患者死于 CVD 的可能性高于进展为终末期肾病（ESKD）。脂代谢异常是 CVD 的一个已知传统危险因素，在 CKD 患者中非常普遍，在接受透析治疗的 ESKD 患者中更为常见。持续不卧床腹膜透析（CAPD）患者长期暴露于 CAPD 液中的高葡萄糖浓度与心血管事件风险增加有关。在这项研究中，我们调查了在南非黑人 CKD（KDOQI 第 3 阶段）和 CAPD 及血液透析（HD）的 ESKD 患者中，动脉粥样硬化血管疾病（AsVD）与临床和超声心动图参数之间的关系。
这是一项横断面研究，纳入了 40 名成年（18-65 岁）非糖尿病 CKD 患者（肾脏病预后质量倡议 [KDOQI] 第 3 阶段）、40 名 CAPD 上的 ESKD 患者、40 名 HD 上的 ESKD 患者和 41 名年龄和性别匹配的健康对照组。使用问卷调查收集参与者的社会人口学和心血管危险因素信息。测量人体测量参数。分析血清血液样本中的肌酐、白蛋白和脂质谱；计算脂蛋白比值、弗雷明汉风险评分和发展冠心病（CHD）的 10 年风险。对所有患者进行超声心动图检查，并在右侧和左侧颈动脉距颈动脉球 1 cm 处测量颈动脉内膜中层厚度（CIMT）。进行 Spearman 秩相关和二元逻辑回归分析，以确定 AsVD 与临床和超声心动图参数的关系。
CAPD 上的 ESKD 患者中最常见的是 AsVD（70%，n=28/40）。CKD 和 HD 患者的患病率相似（47.5%，n=19/40），而对照组的患病率为 17.1%（n=7/41）。存在 AsVD 与年龄较大、腰臀比（WHR）较高、左心室质量指数（LVMI）和弗雷明汉 10 年 CHD 发病风险显著相关。比较研究组时，观察到临床和超声心动图参数存在显著差异。年龄和 LVH 独立预测 AsVD。
与透析前 CKD 和 HD 患者相比，CAPD 患者中更常见的是 AsVD。在所评估的所有脂蛋白比值中，非高密度脂蛋白胆固醇（非-HDL-C）在各组之间表现出最一致的显著差异。年龄（>40 岁）和 LVH 是 AsVD 的独立预测因素。
