Relationship Between Advanced Oxidation Protein Products And Cardiovascular Disease In Nondialytic Patients With Chronic Kidney Disease Ⅴ Stage

Background: Cardiovascular disease (CVD) is the most common complication of chronic kidney disease (CKD) and the principal cause of death. The patients of CKD have two main kinds of CVD: artery vessel disease, including atherosclerosis and arteriolar sclerosis; and myocardium disease, including left ventricular hypertrophy (LVH) and left ventricular dilation. Traditionally common risky factors of CVD exist in CKD patients, but they can not satisfactorily explain the high incidence and death rate of CVD. This suggests that there would be other non common risky factors. Advanced oxidation protein products (AOPPs) are the outcome of oxidation of albumin and hypochlorous acid, and it is an important marker for the damages of the protein through oxidation introduction. Researches have shown that AOPPs not only act as an indicator for oxidative stress but also play an important role in the occurrence and development of pathological, physiological and dialysis-related complications of CKD patients. And their relation with CVD attracts our attention. A few researches mainly approach this problem from different angles the relationship between AOPPs and atherosclerosis. Yet study of the relationship between AOPPs with myocardium diseases, esp. LVH has not been reported. Based on the study of CKD V stage non-dialytic patients by means of determining the AOPPs levels, carotid atherosclerosis indexes and LVH indexes, this research is expected to investigate the effects and related affecting factors of plasma AOPPs on atherosclerosis and LVH of CKDV stage non-dialytic patients.Methods: Plasma AOPPs of observed group and control group are tested. Philips IE-33 Color-Coded Duplex Sonography is used to determine carotid atherosclerosis and LVH indexes. The statistical processes are conducted through SPSS10.0. The comparisons between the variables are made by t test and x~2 test. The correlation analysis is made by Pearson method. Multi-regression analysis is made by means of multiple linear stepwise regressions. The differences are considered to be statistically significant when P<0.05.Results: (1) The serum AOPPs level of the observed group is obviously higher than control group (P=0.000). The observed group is subdivided into two groups on whether the primary disease is diabetes, and there is no obvious AOPPs difference between the subgroups (P=0.250). (2) Forty five patients are examined with carotid artery ultrasound. Thirty one patients (68.89%) have carotid plaque. The AOPPs difference between the two subgroups is statistically significant (P=0.025). And correlation analysis shows that positive correlation exists between AOPPs level and the common carotid artery IMT (r=0.593, P=0.000) and common carotid artery branches IMT (r=0.489, P=0.001). Multiple linear stepwise regressions analysis shows that AOPPs (β=0.574, P=0.000;β=0.469, P=0.000) and age (β=0.485, P=0.000;β=0.545, P=0.000) are obvious correlating factors to common carotid artery IMT and common carotid artery branches IMT. (3) Forty eight patients are examined by color-coded duplex sonography. Thirty eight patients (79.17%) have LVH. The difference of AOPPs between the two subgroups is statistically significant (P=0.016). Correlation analysis shows that positive correlation exists between AOPPs level and LVMI (r=0.355, P=0.013). Multiple linear stepwise regressions analysis shows that AOPPs (β= 0.336, P=0.015) and cholesterol (β= -0.291, P=0.033) are obvious correlating factors to LVMI. (4) Thirty four patients (34%) have previous CVD. Through comparison it has been found that those having previous CVD have obviously higher serum AOPPs [ (22.29±9.20) vs. (16.89±3.40) umol/L, P=0.029].Conclusion: (1) Non-dialytic CKD V stage patients generally have higher AOPPs levels, which are not related to whether the primary disease is diabetes. (2) These patients generally have atherosclerosis. Correlation analysis and multiple linear stepwise regressions analysis shows that AOPPs are an independent risky factor to common carotid artery IMT, which indicates that AOPPs may be involved in the occurrence and progress of atherosclerosis of non-dialytic CKD V stage patients. (3) These patients generally have LVH. Correlation analysis and multiple linear stepwise regressions analysis shows that AOPPs are an independent risky factor to LVH, which indicates that AOPPs may be involved in the occurrence and progress of the abnormality of heart's structure and functions of CKD patients.