Clinical Investigation Of Relationship Between Vascular Endothelial Groweth Factor(VEGF) And Peritoneal Function In Peritoneal Dialysis Patients

Background:Background:Peritoneal Dialysis(PD)is a kind of renal replacement therapy for end stage renal disease(ESRD)patients.In recent years,more and more attention has been drawn to the complication of peritoneal dialysis.Peritoneal transport characteristics have significant impacts on the efficiency of the quality and prognosis in peritoneal dialysis patients.Peritoneal angiogenesis is one of the mechanisms that affect the function of peritoneal solute transport,causing peritoneal fibrosis and ultrafiltration failure.Vascular endothelial growth factor(VEGF),is the key factor of angiogenesis.The action of renin angiotensin aldosterone system(RAAS)is an important part of the series of pathophysiological processes by affecting VEGF.Objective:1.To investigate the effects of serum VEGF and peritoneal fluid VEGF concentrations in peritoneal dialysis patients,and effects of VEGF mediated angiogenesis on peritoneal transport function.2.Study the RAAS inhibitor to reduce the level of VEGF and protein which losses from peritoneal dialysis fluid.Methods and Rsults:PART1:The Cross-Sectional Study of the Relationship between VEGF and Peritoneal Transport Function.Materials of 122 patients with regular follow-up from January 2016 to January 2017 in Fuzhou General Hospital of Nanjing Military Command were collected and selected as the main subjects of the study.And those patients were grouped by PET results and level of sVEGF.Among which 10 patients with nephritic syndrome were selected as the control group.The concentrations of VEGF were measured by ELISA.Simultaneous detection of blochemical indexes including ALB,Hb,hemoglobin protein,etc.Single and multiple factor correlation analysis were used to study the related factors of VEGF in peritoneal dialysis patients and the relationship between VEGF and peritoneal transport function.RESULTS:1.According to the transfer coefficient(D/P Cr)grouping comparison results:(1)Concentration of sVEGF in CAPD patients were increased significantly compared with the control group.(2)The level of sVEGF in H group was significantly higher than other different transport group.(3)For pVEGF,H group was significantly higher than other 4 groups.The rest 3 groups were not significant from the control group.2.According to the comparison of the results of dialysis age group,in 1 or 2 years as a group standard,there was no significant difference between sVEGF and Pvegf,but in 3 years as the dividing standard,longer-term dialysis patients sVEGF was higher than short-term group,and there was no obvious in pVEGF.3.The study suggested that in patients with CAPD sVEGF level showed positive correlation with the level of pVEGF.Multi-factor regression analysis showed that the levels of sVEGF,fasting blood glucose,hyperlipidemia are risk factors affecting the level of pVEGF,and sVEGF has the greatest impact.In addition,dialysate glucose concentration is an risk factors of sVEGF and pVEGF with CAPD patients and the apply of ACEI/ARB types of drugs was the protective factor.4.The analysis suggested that MTAC Cr was positively correlated with the level of sVEGF,yet has no correlation between the level of pVEGF.Multi-factor regression analysis showed that sVEGF level is a risk factor of MTAC Cr.5.Correlation analysis showed that dialysate protein level was positively correlated with sVEGF concentration and MTAC Cr.Multi-factor regression analysis showed that peritoneal transport level is risk factor of dialysate protein loss,and the apply of ACEI/ARB was the protective factor.PART2:Effects of Rennin-Angiotensin System Inhibitors Played on VEGF Level in Patients With CAPD,Materials of totally 34 CAPD patients who were regularly followed were collected.Retrospectively,we collected their information include age,sex,primary disease,dialysis age,etc.Twenty cases were treated with ACEI/ARB(the treatment group),forteen cases without used any ACEI/ARB as control group.The observation time is 6 months.Clinical assessment was performed before and after treatment for 6 months respectively.The assessment content includes D/P Cr,KT/V,C Cr and 24-hour peritoneal dialysate protein loses.At the same time we also collected the serum and dialysate samples and determinated the concention of VEGF.Then statistical analysis of datas was performed with SPSS software.RESULTS:1.There was no significant difference between the treatment group and the control group in the base date,such as gender,age,dialysis age,blood pressure and primary disease,ect.2.There were no significant difference between two groups of clinical indicators at the beging and afeter 6 months.3.In the base line level,there was no statistical significance in sVEGF level between the treatment group and the control group.After six months of treatment,sVEGF of patients applied ACEI/ARB was significantly lower compare to those not using.4.In the baseline of pVEGF,there was no different between treatment group and control group.And after 6 months of treatment,level of pVEGF in the patients who were applied ACEI/ARB were lower than the group not,but the difference wass not significant.5.At the beginning,there was no difference between two groups in dialysate protein loses,but with 6 months of treatment the group used ACEI/ARB had lower dialysate protein loses than the control group.CONCLUSION:1.The higher the level of VEGF,the higher the level of peritoneal transport functions.The two of them are relevant.VEGF may promote peritoneal angiogenesis and increase the permeability of the peritoneal vessels to increase the peritoneal solute transport function.2.The concentration of glucose in dialysis fluid or glucose exposure is an independent risk factor of causing sVEGF and pVEGF.And the application of ACEI/ARB to reduce the production of VEGF is a protective effect.3.The level of VEGF in CAPD patients was negative correlated with serum albumin.VEGF may be lost in the influence of peritoneal transport mediated protein levels in peritoneal dialysi,and resulting hypoproteinemia.Protein loses from peritoneal is associated with peritoneal transport and the level of sVEGF.Higher concention of sVEGF had more protein lost from peritoneal dialysate,suggesting that VEGF may be affected by changing the level of body protein loss of peritoneal transport.4.ACEI/ARB could reduce the level of protein loss and the level of VEGF,suggesting that RAAS blockers inhibit the production of VEGF,reducing peritoneal angiogenesis and its permeability,so as to protect the peritoneal function.