Relationship Between 24-h Peritoneal Protein Losses And Cardiovascular Diseases In Patients On Continuous Ambulatory Peritoneal Dialysis

Background:Cardiovascular disease(CVD) is frequently present in chronic kidney disease(CKD),and peritoneal albumin excretion may be an important predictor of CVD.Here we study the relationship between CVD and 24-h peritoneal protein losses(PPL) in CAPD patients.Methods:178 CAPD(continuous ambulatory peritoneal dailysis )patients in our division were enrolled in this study.Their 24-h PPL were measured and other clinical datas were recorded at the beginning.Meanwhile,echocardiographic were performed.They were then followed prospectively for the development of CVD.Results:The average of 24-h PPL was 4.997±1.795g.A positive correlation between 24-h PPL and body surface area(BSA) was detected.And an inverse correlation with hemoglobin was also demonstrated.But 24-h PPL did not correlated with totle KT/V and totle Ccr.Patients with diabetic status and preexisting CVD had higher 24-h PPL than those without,and the rusults were statistically significant(P=0.039,0.010).24-h PPL did not differ between groups with and without primary hypertention history,receiving treatment with angiotensin-converting enzyme inhibitor(ACEI) or angiotensionⅡreceptor(ARB),peritonitis history,respectively.Echocardiographic examination showed that 24-h PPL were positively correlated with left ventricular end-diastolic diameter(LVDd) and interventricular septal thickness(IVSTd) and posterior wall diameter of left ventricle at end-diastolic(LVPWd) and left ventricular mass index(LVMI)(P=0.04,0.043,0.002,0.007,respectively).It also was negatively correlated with ejection fraction of left ventricle(LVEF%)(P=0.04).111 CAPD patients were prospectively followed for at least twelve months.The average duration of follow-up was 15.3±1.5 months.We devided the patients into those with "high"(≥the second quartile P50 of the 24-h PPL) and those with "low"(＜P50) peritoneal protein losses groups.Patients developing CVD were 40.4%and 19.3%for high and low groups respectively(chi-square value =6.035,P=0.014).In the multivariable logistic regression analysis,the 24-h PPL was one of the independent factors for developing CVD.In this model,for every 2-gram increase in 24-h PPL,the adjusted hazard ratio of developing CVD was 2.2.Conclusion:Our study demonstrated a significant and independent relationship between 24-h PPL and new cardiovascular events.We conclude that 24-h PPL may be an important predictor of cardiovascular disease.