Introduction: Vascular calcification and arterial stiffening are cardiovascular risk factors among chronic kidney disease patients. Elevated aortic pulse wave velocity (AoPWV) is an independent predictor of increased cardiovascular morbidity and mortality.
Objectives: The aim of the study was to analyze the relationships between inflammatory and vascular calcification parameters and arterial wall stiffness in chronic kidney disease (CKD) patients treated by peritoneal dialysis.
Patients and methods: The study included 57 patients (27 women and 30 men) aged from 19 to 75 years (mean age 53 ± 13), treated by peritoneal dialysis during 4–100 months (mean 30.4 months). The concentrations of albumin, lipids, interleukin-6 (IL-6), IL-18, high-sensitive C-reactive protein, transforming growth factor-β1 (TGF-β1), osteocalcin, osteoprotegerin (OPG), fibroblast growth factor 23, fetuin A, parathyroid hormone (iPTH), total calcium (Ca), and phosphates (Pi) were measured. AoPWV was performed using a tonometric method, common carotid artery intima–media thickness (CCA-IMT) by ultrasonography evaluation, and calcium scoring (CaSc) with multirow spiral computed tomography (MSCT).
Results: In univariate analysis, AoPWV correlated negatively with osteocalcin (R = −0.37; P = 0.005) and positively with OPG (R = 0.41; P = 0.002). Additionally, AoPWV was significantly positively associated with inflammatory parameters: IL-6 (R = 0.35; P = 0.009), TGF-β1 (R = 0.27; P = 0.047), and white blood cell (WBC) count (R = 0.33; P = 0.01). There were also positive correlations between AoPWV and imaging data: CCA-IMT (R = 0.32; P = 0.02) and CaSc (R = 0.38; P = 0.004). AoPWV did not correlate with calcium, phosphate, Ca × Pi index, or iPTH concentration. After multiple adjustments, osteocalcin was the only significant predictor of AoPWV. In logistic regression adjusted for age, hypertension, and mean arterial pressure at AoPWV evaluation, only osteocalcin was significantly associated with high (above median) AoPWV values [odds ratio 0.96 (0.92–0.99) per unit increase in osteocalcin].
Conclusion: OPG concentration and some inflammatory markers (WBC count, IL-6, TGF-β1) influenced the severity of arterial wall stiffness in CKD patients. Measurement of osteocalcin seems to be the best predictor of AoPWV.
aDepartment of Nephrology
bDepartment of Medical Diagnostics
cDepartment of Internal Medicine and Gerontology
dDepartment of Clinical Biochemistry, Jagiellonian University, Collegium Medicum, Cracow, Poland
Correspondence to Marcin Krzanowski, Department of Nephrology, Jagiellonian University, Kopernika 15C Street, Cracow, Poland. E-mail: firstname.lastname@example.org
Abbreviations AoPWV, aortic pulse wave velocity; Ca, total calcium; CaSC, calcium scoring; CCA-IMT, common carotid artery intima–media thickness; CKD, chronic kidney disease; FGF 23, fibroblast growth factor 23; hsCRP, high-sensitive C-reactive protein; IL-18, interleukin-18; IL-6, interleukin-6; iPTH, parathyroid hormone; MSCT, multirow spiral computed tomography; OPG, osteoprotegerin; Pi, phosphates; RRF, residual renal function; TGF-β1, transforming growth factor beta 1
Received 25 November, 2012
Revised 28 May, 2013
Accepted 26 July, 2013