| 1. |
- Cheng, LT, et al.
(författare)
-
Sex difference in the prevalence of left ventricular hypertrophy in dialysis patients
- 2009
-
Ingår i: American journal of nephrology. - : S. Karger AG. - 1421-9670 .- 0250-8095. ; 29:5, s. 398-405
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Left ventricular hypertrophy (LVH) is an important, independent negative predictor of cardiovascular morbidity and mortality in the general population and in dialysis patients. Previous studies suggest a sex dimorphism in the prevalence of LVH; however, this issue has never been approached in dialysis patients. <i>Methods:</i> This study enrolled 237 prevalent dialysis patients: 49 on hemodialysis (HD) and 188 on peritoneal dialysis (PD) from a single center. LVH was defined by echocardiography measurements, which were normalized to body surface area (BSA) and height<sup>2.7</sup>, respectively. <i>Results:</i> The mean ages in HD and PD patients were 60 ± 14 and 60 ± 13 years, with a median dialysis vintage of 43 and 20 months, respectively. Although there was no significant difference in age, diabetes, proportion of uncontrolled hypertension, antihypertensive medication and blood pressure between male and female patients within each dialysis modality, the prevalence of LVH (whether indexed to BSA or height<sup>2.7</sup>) was consistently higher in females than in males. When these patients were divided into LVH or non-LVH groups, a significant difference in sex distribution was observed between the two groups (62.0% vs. 41.0% when the BSA-indexed standard was used, p < 0.01; 62.8% vs. 37.1% when the height<sup>2.7</sup>-indexed standard was used, p < 0.001). In logistic regression analysis, female sex was identified as a risk factor of LVH (odds ratio, OR = 2.48, 95% confidence interval, CI = 1.33–4.59; when BSA-indexed LVH was treated as dependent variable, and OR = 4.05, 95% CI = 1.96–8.38, when height<sup>2.7</sup>-indexed LVH was treated as dependent variable) even after adjustment for age, diabetes, blood pressure and antihypertensive medication. <i>Conclusion:</i> This study showed that the prevalence of LVH determined by echocardiography was significantly higher in female dialysis patients than in male dialysis patients. Compared with males, female patients had a 2.5- to 4-fold higher risk to develop LVH even after adjustment for other potential confounding factors, which may indicate that elderly females in the uremic scenario are more prone to develop LVH than elderly males.
|
|
| 2. |
- Gu, Y, et al.
(författare)
-
Strong association between nutritional markers and arterial stiffness in continuous ambulatory peritoneal dialysis patients
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:4, s. 340-346
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Malnutrition is a predictor of cardiovascular disease in dialysis patients, but the mechanisms remain unknown. We investigated links between nutritional markers and arterial stiffness in continuous ambulatory peritoneal dialysis patients. <i>Methods:</i> We evaluated the relationship between arterial stiffness evaluated by pulse-wave velocity (PWV) and four estimates of nutritional status (serum albumin, handgrip strength [HGS], subjective global assessment [SGA], and bioelectrical impedance analysis phase angle [PA]) in 124 PD patients. <i>Results:</i> Malnourished patients exhibited a significantly higher PWV than those classified as well-nourished by SGA (p < 0.05). Furthermore, PWV correlated negatively with albumin, HGS and PA (p < 0.001, respectively). PWV was also correlated with age, systolic blood pressure, and C-reactive protein. In multivariate regression analysis, albumin, HGS, SGA and PA were each independently associated with PWV after adjustment. <i>Conclusions:</i> The significant association between each nutritional marker and PWV in PD patients was independent of inflammation and diabetic state, suggesting that malnutrition may contribute to vascular dysfunction.
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
- Yang, JH, et al.
(författare)
-
Volume overload in patients treated with continuous ambulatory peritoneal dialysis associated with reduced circadian blood pressure variation
- 2008
-
Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 26:5, s. 399-403
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> While a high blood pressure (BP) in patients receiving maintenance ambulatory peritoneal dialysis (CAPD) is associated with congestive heart failure and an increased mortality, the relevance of diurnal variations in BP is unknown. <i>Methods:</i>In a prospective study, we enrolled 76 prevalent patients receiving stable CAPD (age 60.4 ± 13.8 years; 37 males). BP was measured over 24 h using an automated device. We also performed routine clinical and biochemical measurements, as well as the Karnofsky index to evaluate physical activity. Volume status was assessed using bioimpedance analysis. <i>Results:</i> 69 patients (with an average time on dialysis of 24.4 ± 22.5 months) completed the study. Of these, 16 patients experienced a drop in BP >10% at night (dippers), while 53 patients did not (non-dippers). Comparing these two groups, dippers had significantly lower extracellular water (ECW) (13.8 ± 2.1 vs. 15.9 ± 3.3 l; p < 0.05), normalized extracellular water (nECW) (0.22 ± 0.05 vs. 0.26 ± 0.04 l/m; p < 0.05), and serum albumin (38.2 ± 2.9 vs. 35.9 ± 3.7 g/l; p < 0.05). Age, Karnofsky index, vintage, residual renal Kt/V and peritoneal Kt/V, total Kt/V, dose of antihypertensive drugs, mean systolic and diastolic BP did not significantly differ between these groups. Correlation analysis showed the coefficient of variation (CV) of BP positively correlated with E/T (r<sup>2</sup> = 0.292; p < 0.05), diabetic (r<sup>2</sup> = 0.267; p < 0.05), male (r<sup>2</sup> = 0.257; p < 0.05), nECW (r<sup>2</sup> = 0.278; p < 0.05) and ECW (r<sup>2</sup> = 0.249; p < 0.05) negatively correlated with albumin (r<sup>2</sup> = –0.280; p < 0.05). Furthermore, in a multivariate linear regression model, E/T, albumin and sex were independently associated with CV for BP. <i>Conclusions:</i> We show that reduced BP variation is common in CAPD patients and associated with volume overload and hypoalbuminemia. Furthermore, the relationship between nutritional, inflammatory status and dipping needs further studies.
|
|
| 7. |
- Zhe, XW, et al.
(författare)
-
Pulse wave velocity is associated with metabolic syndrome components in CAPD patients
- 2008
-
Ingår i: American journal of nephrology. - : S. Karger AG. - 1421-9670 .- 0250-8095. ; 28:4, s. 641-646
-
Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Overall, the proportion of deaths due to cardiovascular disease (CVD) reached 40–50% in dialysis patients. Pulse wave velocity (PWV) reflects arterial stiffness and may provide an integrated index of vascular status and CVD risk. Individual components of the metabolic syndrome (MetS) are well-established cardiovascular risk factors. Thus we conducted a cross-sectional study in continuous ambulatory peritoneal dialysis (CAPD) patients to explore the association of MetS components with PWV. <i>Methods:</i> Prevalent CAPD patients (n = 148, 63 M/85 F) were categorized according to the number of traits of the MetS into one of three groups (No MetS, Risk of MetS, MetS). Due to the effect of peritoneal dialysis (PD), waist circumference was not assessed. Aortic stiffness was assessed by carotid-femoral PWV (C-F PWV). <i>Results:</i> Patients’ MetS trait numbers were positively associated with C-F PWV (r = 0.301, p < 0.01), pulse pressure (r = 0.256, p < 0.01), systolic blood pressure (r = 0.233, p < 0.01), and serum albumin (r = 0.205, p < 0.05). In a multivariate regression analysis, PWV was independently determined by age (p < 0.01) and MetS score (p = 0.01). Adjusted R<sup>2</sup> of the model was 0.24. <i>Conclusion:</i> MetS traits were closely associated with an increased C-F PWV, even after adjustment for confounders. This suggests that commonly recognized MetS criteria are useful also when predicting CVD in CAPD patients.
|
|
