Relationship between High-Sensitivity C-Reactive Protein and Peripheral Vascular Disease in Maintenance Dialysis Patients

Lee, Young Sook; Choi, Kyu Bok

Abstract

BACKGROUND
Pheripheral vascular disease (PVD) is a risk marker for coronary artery disease, cerebrovascular disease, diabetes mellitus, hypertension and many other diseases. The cardiovascular mortality rate in dialysis patients is greater than that in general population. The aim of our study was to explore the distribution, risk factors of PVD by ankle- brachial index (ABI) and the relationship with inflammation by measurement of hsCRP in maintenance dialysis patients. METHODS: We measured ABI by doppler ultrasono in 130 maintenance dialysis patients (HD 86 patients, PD 44 patients) who undergoing dialysis for at least three months. Also, we classified the severity of PVD based upon ABI levels and compared the relation with systemic inflammation marker - hsCRP and many other clinical parameters. RESULTS: PD patients had significantly higher BMI with lower mean serum albumin for 6 months and serum BUN compared with HD patients. The frequency of PVD (ABI<0.9) was not different between the groups but ABI was significantly lower in HD patients than PD patients (0.95+/-0.21 vs 0.85+/-0.30, p<0.05). The mean of hsCRP tended to be lower in PD patients than in HD patients but did not reach stastical significance (0.31+/-0.35 vs 0.47+/-0.85, p=0.147). More severe PVD had higher mean hsCRP in whole dialysis patients and HD patients but PD patients didn't. The higher quartiles had older age, increased frequency and severity of PVD and significantly decreased ABI. The group with PVD(ABI<0.9) had a higher mean of hsCRP, older age, longer dialysis duration and diabetes. Multiple regression analysis demonstrated that hsCRP, diabetes, age, dialysis duration predicted ABI with R2=0.488 and p=0.000 in whole dialysis patients. hsCRP, age, dialyis duration, the presence of diabetes and coronary artery disease predicted ABI in HD patients. But only age predicted ABI in PD patients. CONCIUSION: We conclude that the risk factors of PVD may be different between the PD patients and HD patients. And the pathophysiologic implication on cardiovascular morbidity and mortality of same risk factors may be different between the groups.