THE ASSOCIATION OF DYSLIPIDEMIA WITH INTRAPERITONEAL INFLAMMATION AND PERITONEAL DIALYSIS TECHNIQUE SURVIVAL

  • N. Stepanova SI «Institute of Nephrology NAMS of Ukraine»
  • O. Burdeyna SI «Institute of Nephrology NAMS of Ukraine»
  • I. Dudar SI «Institute of Nephrology NAMS of Ukraine»
  • V. Driyanska SI «Institute of Nephrology NAMS of Ukraine»
  • L. Snisar SI «Institute of Nephrology NAMS of Ukraine»
  • I. Shifris SI «Institute of Nephrology NAMS of Ukraine»
  • E. Krasyuk Kyiv City Research Center of Nephrology and dialysis
  • A. Shimova Kyiv City Research Center of Nephrology and dialysis
Keywords: peritoneal dialysis, intraperitoneal inflammation, dyslipidemia, technique survival, monocytic chemoattractant protein-1, interleukin-10, tumor necrosis factor-a.

Abstract

The aim of the study was to determine the relationship between the dyslipidemia, intraperitoneal inflammation and peritoneal dialysis (PD) survival.

Patients and methods. A total of 40patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis (PD) have been included in a prospective, observational study (average age was 49.3 ± 12.7). All patients were determined the blood lipid spectrum and IL-10, TNF-a, MCP-1 levels in peritoneal dialysis effluent (PDE). PD adequacy indicators evaluated by determining the concentration of urea and creatinine in plasma, urine and dialysate, calculated weekly creatinine clearance (CrCl), dialysis (Kt/ Vd), renal (Kt/ Vr) and total weekly urea clearance (Kt/ V).

Results. Dyslipidemia defined as increase of atherogenic lipoprotein fractions and inhibition ofHDL cholesterol was identified in 70% of the PD-patients. LDL cholesterol level and, accordingly, an atherogenic index (AI) were significantly dependent on the duration of PD treatment (R2 = 2.18 ± 0.15 (95% CI 1.87, 2.5), p < 0,0001 and R2 = 2.77 ± 0.27(95% CI 2.2, 3.3), p < 0,0001). The blood levels of total cholesterol, LDL-C and TG in the patients with diabetes were significantly higher compared with the diabetes-free patients (p = 0.007, p = 0.001 andp = 0.02, respectively).

Reducing the HDL cholesterol level was associated with high intraperitoneal production of pro-inflammatory mediators TNF-a (r = - 0.53;p = 0.001) and anti-inflammatory IL-10 (r = - 0.783;p <0.0001), whereas hypertriglyceridemia and high VLDL cholesterol are associated with an increase of MCP-1 (r = 0.6;p = 0.0003 and r = 0.55;p = 0.002, respectively).

The Cox proportional hazards regression analysis demonstrated the significant effect of VLDL cholesterol, LDL cholesterol and AI on the survival of PD technique survival (x2 = 24.8; p < 0.0001). The results of the Kaplan–Meier analysis and log-rank test also identified that there was a significant difference in the cumulative technical survival rate between the patients with AI level < 3.5 and > 3.5 (log-rank test: x2 = 19.8, P = 0.001.

Conclusions. Our results can be considered dyslipidemia in PD-patients not only as a traditional risk factor for CVD, but also as a predictor of chronic intraperitoneal inflammation and decrease of PD technical survival.

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Published
2017-05-29
How to Cite
Stepanova, N., Burdeyna, O., Dudar, I., Driyanska, V., Snisar, L., Shifris, I., Krasyuk, E., & Shimova, A. (2017). THE ASSOCIATION OF DYSLIPIDEMIA WITH INTRAPERITONEAL INFLAMMATION AND PERITONEAL DIALYSIS TECHNIQUE SURVIVAL. Ukrainian Journal of Nephrology and Dialysis, (2(54), 39-46. https://doi.org/10.31450/ukrjnd.2(54).2017.08

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