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Rebić D, Begić E, Aziri B, Džubur A, Gogić E, Durak-Nalbantić A, Hamzić-Mehmedbašić A, Hasanspahić S, Granov N. The Role of Dyslipidemia in Atherogenesis in Peritoneal Dialysis Patients. Adv Biomed Res 2023; 12:135. [PMID: 37434937 PMCID: PMC10331554 DOI: 10.4103/abr.abr_1_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 07/13/2023] Open
Abstract
Background To evaluate atherosclerotic changes in carotid arteries (CCA) in uremic patients before and after 18 months of continuous ambulatory peritoneal dialysis (CAPD) treatment, and to evaluate the impact of dyslipidemia and CAPD treatment on vascular remodeling. Materials and Methods We conducted a longitudinal, prospective study during 2020 and 2021 at the Clinic for Nephrology, Clinical Center University of Sarajevo. Patients with end-stage renal disease were included and were followed during 18 months of CAPD treatment. All patients were treated using commercially prepared biocompatible balanced dialysis solutions. Carotid intima-media thickness (IMT) and atherosclerotic plaques on the common carotid artery (CCA) were measured by echotomography. Results A total of 50 patients were included and were followed during 18 months of CAPD treatment. Lipid values in the serum of patients with CAPD were significantly lower after 18 months of CAPD treatment compared to the values before treatment, while the value of high-density lipoprotein (HDL) was significantly increased after 18 months of CAPD treatment. The values of IMT and the diameter of the CCA compared to the basal values were significantly lower (P < 0.001). Conclusion We demonstrated significantly lower lipid values and higher HDL levels following CAPD treatment. Correct selection of the targeted pharmacological intervention can substantially impact the regression of vascular changes in patients on peritoneal dialysis.
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Affiliation(s)
- Damir Rebić
- Department for General Nephrology, Clinic for Nephrology, Sarajevo, Bosnia and Herzegovina
| | - Edin Begić
- Department of Cardiology, General Hospital “Prim.Dr. Abdulah Nakaš”, Sarajevo, Bosnia and Herzegovina
- Department of Pharmacology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Buena Aziri
- Department of Pharmacology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Alen Džubur
- Department of Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ena Gogić
- Department of Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Azra Durak-Nalbantić
- Department of Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Senad Hasanspahić
- Department for General Nephrology, Clinic for Nephrology, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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San Norberto EM, Revilla Á, Fernández-Urbón A, Gómez-Giralda B, Taylor JH, Vaquero C. Vascular calcification progression in patients with end-stage chronic kidney disease. INT ANGIOL 2021; 40:528-536. [PMID: 34515450 DOI: 10.23736/s0392-9590.21.04698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intima media thickness (IMT), vascular calcifications and ankle-brachial pressure index (ABPI) were shown to be independent predictors of mortality in end-stage renal disease (ESRD) patients. METHODS Between January 2018 and March 2019, a physician-initiated, nonrandomized, prospective study was conducted. Carotid IMT, vascular calcifications analysis values and measurements of the ABPI, were made at baseline and after 1-year of follow-up. RESULTS A total of 284 patients, 152 patients with dialysis (100 hemodialysis (HD) and 52 CAPD (continuous ambulatory peritoneal dialysis)) and 132 patients with stage 4 chronic kidney disease (control group), were included (55% male, 67 [29-88] years). The values of carotid IMT at baseline were higher in the HD group than in the CAPD group (1.10±0.08 mm vs. 0.08±0.04 mm, P=0.004). Adragao and Kauppila scores were higher in the HD group than in the CAPD group (2.56±2.10 vs. 1.08±2.02, P=0.009; and 7.40±6.86 vs. 4.44±5.26, P<0.001; respectively). These differences remained after 1-year of follow-up. Pathological ABPI after 1-year follow-up was more prevalent in the HD group than in the CAPD or control groups (32.0% vs. 19.4% vs. 7.7%, respectively, P=0.042). Multivariate regression analysis revealed that age, gender, dialysis type and LDLc were independent predictors for carotid IMT increase; age, dialysis type and smoking for vascular calcifications increase on Adragao Score; and dialysis type on Kauppila Score. Only the dialysis type was the independent predictor for all vascular calcifications markers. CONCLUSIONS Dialysis, particularly HD, is an independent risk factor for cardiovascular calcification increase in ESRD patients.
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Affiliation(s)
| | - Álvaro Revilla
- Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
| | - Ana Fernández-Urbón
- Department of Anesthesiology, Valladolid University Hospital, Valladolid, Spain
| | | | - James H Taylor
- Department of Cardiac Surgery, Valencia General University Hospital, Valencia, Spain
| | - Carlos Vaquero
- Department of Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
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Piko N, Bevc S, Ekart R, Petreski T, Vodošek Hojs N, Hojs R. Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk. World J Diabetes 2021; 12:975-996. [PMID: 34326949 PMCID: PMC8311487 DOI: 10.4239/wjd.v12.i7.975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/04/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc.) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.
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Affiliation(s)
- Nejc Piko
- Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Sebastjan Bevc
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
- Medical Faculty, University of Maribor, Maribor 2000, Slovenia
| | - Robert Ekart
- Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
- Medical Faculty, University of Maribor, Maribor 2000, Slovenia
| | - Tadej Petreski
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
- Medical Faculty, University of Maribor, Maribor 2000, Slovenia
| | - Nina Vodošek Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Radovan Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
- Medical Faculty, University of Maribor, Maribor 2000, Slovenia
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Palmerini C, Piscitani L, Bologna G, Riganti C, Lanuti P, Mandatori D, Di Liberato L, Di Fulvio G, Sirolli V, Renda G, Pipino C, Marchisio M, Bonomini M, Pandolfi A, Di Pietro N. Predialysis and Dialysis Therapies Differently Affect Nitric Oxide Synthetic Pathway in Red Blood Cells from Uremic Patients: Focus on Peritoneal Dialysis. Int J Mol Sci 2021; 22:ijms22063049. [PMID: 33802652 PMCID: PMC8002384 DOI: 10.3390/ijms22063049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Red blood cells (RBCs) have been found to synthesize and release both nitric oxide (NO) and cyclic guanosine monophosphate (cGMP), contributing to systemic NO bioavailability. These RBC functions resulted impaired in chronic kidney disease (CKD). This study aimed to evaluate whether predialysis (conservative therapy, CT) and dialysis (peritoneal dialysis, PD; hemodialysis, HD) therapies used during CKD progression may differently affect NO-synthetic pathway in RBCs. Our data demonstrated that compared to PD, although endothelial-NO-synthase activation was similarly increased, HD and CT were associated to cGMP RBCs accumulation, caused by reduced activity of cGMP membrane transporter (MRP4). In parallel, plasma cGMP levels were increased by both CT and HD and they significantly decreased after hemodialysis, suggesting that this might be caused by reduced cGMP renal clearance. As conceivable, compared to healthy subjects, plasma nitrite levels were significantly reduced by HD and CT but not in patients on PD. Additionally, the increased carotid intima-media thickness (IMT) values did not reach the significance exclusively in patients on PD. Therefore, our results show that PD might better preserve the synthetic NO-pathway in CKD-erythrocytes. Whether this translates into a reduced development of uremic vascular complications requires further investigation.
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Affiliation(s)
- Carola Palmerini
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (C.P.); (D.M.); (C.P.); (A.P.)
- Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (G.B.); (P.L.); (M.M.)
| | - Luca Piscitani
- Nephrology and Dialysis Unit, SS. Annunziata Hospital, 66100 Chieti, Italy; (L.P.); (L.D.L.); (G.D.F.); (V.S.); (M.B.)
| | - Giuseppina Bologna
- Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (G.B.); (P.L.); (M.M.)
- Department of Medicine and Aging Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Chiara Riganti
- Department of Oncology, University of Torino, 10124 Torino, Italy;
| | - Paola Lanuti
- Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (G.B.); (P.L.); (M.M.)
- Department of Medicine and Aging Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Domitilla Mandatori
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (C.P.); (D.M.); (C.P.); (A.P.)
- Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (G.B.); (P.L.); (M.M.)
| | - Lorenzo Di Liberato
- Nephrology and Dialysis Unit, SS. Annunziata Hospital, 66100 Chieti, Italy; (L.P.); (L.D.L.); (G.D.F.); (V.S.); (M.B.)
- Department of Medicine and Aging Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Giorgia Di Fulvio
- Nephrology and Dialysis Unit, SS. Annunziata Hospital, 66100 Chieti, Italy; (L.P.); (L.D.L.); (G.D.F.); (V.S.); (M.B.)
| | - Vittorio Sirolli
- Nephrology and Dialysis Unit, SS. Annunziata Hospital, 66100 Chieti, Italy; (L.P.); (L.D.L.); (G.D.F.); (V.S.); (M.B.)
- Department of Medicine and Aging Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy;
- Cardiology Unit, SS. Annunziata Hospital, 66100 Chieti, Italy
| | - Caterina Pipino
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (C.P.); (D.M.); (C.P.); (A.P.)
- Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (G.B.); (P.L.); (M.M.)
| | - Marco Marchisio
- Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (G.B.); (P.L.); (M.M.)
- Department of Medicine and Aging Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Mario Bonomini
- Nephrology and Dialysis Unit, SS. Annunziata Hospital, 66100 Chieti, Italy; (L.P.); (L.D.L.); (G.D.F.); (V.S.); (M.B.)
- Department of Medicine and Aging Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy
| | - Assunta Pandolfi
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (C.P.); (D.M.); (C.P.); (A.P.)
- Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (G.B.); (P.L.); (M.M.)
| | - Natalia Di Pietro
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (C.P.); (D.M.); (C.P.); (A.P.)
- Center for Advanced Studies and Technology-CAST (ex CeSI-MeT), G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy; (G.B.); (P.L.); (M.M.)
- Correspondence:
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GÜNEŞLİ A, TEKKARIŞMAZ TÖRER N. Karotis elastisite ve distensibilitesinin son dönem böbrek yetmezliği olan hastalar ve sağlıklı gönüllüler arasında karşılaştırılması. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.644489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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