Comparison of Markers of Oxidative Stress, Inflammation and Arterial Stiffness Between Incident Hemodialysis and Peritoneal Dialysis Patients – An Observational Study

Robert G. Fassett; Ritza Driver; Helen Healy; Dwarakanathan Ranganathan; Sharad Ratanjee; Iain K. Robertson; Dominic P. Geraghty; James E. Sharman; Jeff S. Coombes

Disclosures

BMC Nephrology 

In This Article

Abstract and Background

Abstract

Background: Patients on peritoneal and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. The atherosclerosis is associated with increased arterial stiffness, endothelial dysfunction and elevated oxidative stress and inflammation. The aims of this study are to investigate the effects of peritoneal and hemodialysis on arterial stiffness, vascular function, myocardial structure and function, oxidative stress and inflammation in incident patients with end stage kidney disease.
Methods: This is an observational study. Eighty stage five CKD patients will be enrolled and followed for one-year. Primary outcome measures will be changes in 1) arterial stiffness measured by aortic pulse wave velocity, 2) oxidative stress assessed by plasma F2 isoprostanes and 3) inflammation measured by plasma pentraxin-3. Secondary outcomes will include additional measures of oxidative stress and inflammation, changes in vascular function assessed using the brachial artery reactivity technique, carotid artery intimal medial thickness, augmentation index and trans thoracic echocardiography to assess left ventricular geometry, and systolic and diastolic function. Patients will undergo these measures at baseline (6–8 weeks prior to starting dialysis therapy), then at six and 12 months after starting dialysis.
Discussion: The results of this study may guide the choice of dialysis modality in the first year of treatment. It may also lead to a larger study prospectively assessing the effect of dialysis modality on cardiovascular morbidity and mortality.

Background

End stage kidney disease (ESKD) patients undergoing dialysis have a substantially increased risk of cardiovascular morbidity and mortality.[1] In 2007, 2311 new patients started dialysis in Australia and New Zealand but, unfortunately, many of these patients will die of cardiovascular disease. (ANZDATA 2007) The decision to undergo either peritoneal or haemodialysis is based on a number of factors. One of the important issues is the potential damage the renal replacement therapy may have on the cardiovascular system. Currently, little is known regarding the differential effects of the dialysis modalities on the cardiovascular system.

Oxidative stress and inflammation are associated with the development of cardiovascular disease in dialysis patients.[1,2] The mechanisms are believed to involve arterial stiffening leading to impaired vascular function.[3] In addition, vascular and myocardial dysfunction are also prominent, increasing the likelihood of cardiovascular disease morbidity and mortality in dialysis patients.[4] A number of studies have documented that peritoneal dialysis is associated with decreased levels of oxidative stress and inflammatory markers compared to haemodialysis.[5] A small number of trials have extended this work to determine associations between oxidative stress and inflammation with vascular or myocardial structure and function with equivocal results.[4,6] To our knowledge, only a few cross sectional studies have compared the effects of different dialysis therapies on surrogate markers of cardiovascular disease.[7,8] As yet, no study has compared the changes in these markers over time in incident dialysis patients.

Measures of arterial stiffness such as aortic pulse wave velocity (PWV) predict morbidity and mortality in patients with kidney disease.[9] Numerous studies have reported that the elevated levels of oxidative stress and inflammation in this population[10,11,12,13,14] are associated with arterial stiffness.[15] Therefore, the purpose of this study is to assess the effect of peritoneal and hemodialysis on arterial stiffness, vascular function, oxidative stress and inflammation and myocardial structure and function. Comparing the effects of dialysis modalities on surrogate cardiovascular markers over time will provide unique important information to assist in the treatment of patients with ESKD. A randomised controlled trial assessing this would be ideal but unethical in Australia as patients are generally given a choice between hemodialysis and peritoneal dialysis.

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