FP522SUBCLINICAL ATHEROSCLEROSIS IN PERITONEAL DIALYSIS AND ITS RELATIONSHIP TO CARDIOVASCULAR OUTCOME

Abstract

Introduction and Aims: Despite advances in peritoneal dialysis (PD), mortality is still high mostly due to cardiovascular diseases. An early management of vascular disease may be the key for improving prognosis of these patients. The aim of the study was to identify prognostic factors for subclinical atherosclerosis and its relationship to cardiovascular outcome in non-diabetic PD patients. Methods: We performed a prospective study. 3 markers of subclinical atherosclerosis were studied: arterial stiffness through applanation tonometry, carotid intima-media thickness (IMT) and valvular calcifications. Independent risk factors for subclinical atherosclerosis were identified by logistic regression using IBM SPSS ver. 20.0. Results: We included 246 non-diabetic patients (118F, 128M), mean age 56.3 + 15.7 years (20-85) in stable PD programme for at least 6 months. 50% of patients had higher pulse wave velocity (PWV) compared to normal values corresponding to age and sex-matched general population. Malnourished patients had a 9.1 risk of increased arterial stiffness (95%CI 1.9-41.4, p=0.007). IMT was higher in patients who developed acute coronary syndrome (1.1860.3 vs 0.83 60.2 mm, p<0.001) or ischemic stroke (1.06 60.2 vs 0.960.2 mm, p=0.02) during study. Mineral disorders, malnutrition and inflammation were closely linked to valvular calcifications as reflected by significant higher serum calcium (9.76 1.01 mg/dl vs8.56 1.1 mg/dl, p<0.001), lower serum total cholesterol (177.26 56.2 vs 202.6 658.4 mg/dl, p=0.02) and increased risk of these calcifications in patients with C-reactive protein >3 mg/l (OR 3.3,95%CI: 1.1-9.7, p=0.03). IMT (0.9+0.2 vs. 0.8+0.2 mm, p=0.003) and PWV (10.4+2.6 vs. 6.9+1.1 m/s, p<0.001) were significantly higher in patients with valvular calcifications and these calcifications were associated with a 9.7 risk of carotid atherosclerosis (95%CI: 2.9-32.5, p<0.001). Age>55 years and HDL-cholesterol <40 mg/dl were independent risk factors for valvular calcifications. After adjusting for confounders, independent predictive factors for increased IMT were age >55 years, loss of residual renal function, and malnutrition as reflected by a serum total cholesterol less than 150 mg/dl and reverse independent correlation with body mass index and total cholesterol to [Figure Presented] Risk for cardiovascular death was 4 times higher in patients with valvular calcifications (95%CI 1.1-14.8, p=0.02) and 4.3 times higher in those with IMT>0.9 mm (95%CI 1.1-16.3, p=0.02), while PWV was higher in patients who died because of cardiovascular disease during study (11.9+2.5 vs 8.6+2.6 m/s, p=0.04). Conclusions: Our study demonstrated an increased prevalence of subclinical atherosclerosis in non-diabetic PD patients and its relationship with acute vascular complications and death. Malnutrition, inflammation and abnormal mineral metabolism were linked to subclinical atherosclerosis and these are potentially treatable risk factors in order to improve cardiovascular prognosis in this population.