| Objective: Hemodialysis and peritoneal dialysis are the most commonways of renal therapy in patients with end-stage renal disease, which cansignificantly reduce the mortality and improve the quality of life. Cardiov-ascular disease is the major cause of disability and death in dialysis patients,and the mortality is about40%-50%.Recent studies have shown that endoth-elial dysfunction is a major pathogenesis of cardiovascular disease. Theimbalance of the level of ET-1/NO system indicates the endothelial dysfun-ction in end-stage renal patients. The purpose of this study is to investigatethe change of the ET-1/NO system level and thefactors affecting this systemin dialysis patients, further to understand thevascular endothelial dysfunctionundergoing dialysis.Methods:40cases of hemodialysis patients and80cases of peritonealdialysis patients without diabetes were enrolled, who dialysis regularly formore than3months. Patients were further divided into groups based on card-iovascular events and carotid intima-media thickness and residual renal func-tion.12cases of normal healthy adults were encrolled as the control group.Mensures: Using the method of radioimmunoassay to assay endothelin-1(ET-1)and nitrate reductase to measure the level of endothelial nitric oxide synthase(eNOS), and recording the basic information of patiens and the result ofbiochemical indexes,such as gender, age, duration of dialysis, type of primarydisease, carotid ultrasound, blood pressure, residual renal function, cardiova-scular disease, Hb, TP, Alb, Ca, P, TC, TG, LDL, Hcy, HsCRP, UA.Results:1There were80cases of peritoneal dialysis patients (male38cases,female42cases), with mean age (42.58±13.25). there are40cases of hemod-ialysis patients(male18cases, female22cases), with average age (46.96- 17.81). There were12cases of healthy controls(male5cases, female7), withaverage age (40.92±5.31). There was no statistical significance among thethree groups in gender, age. The control group blood pressure were lower thanthe dialysis two groups, P<0.05.2Compared with the control group, dialysis patients of the TP, Alb, Hbare significantly decreased, with statistically significant. The control grouphad lower levels of HsCRP, P, TC, TG, LDL, UA, Hcy, SBP, DBP, and hadstatistically significant, P<0.05. Carotid artery intima-mediathickness(CIMT)were: the control group (0.85±0.27)mm, hemodialysis group (1.19±0.39)mm,peritoneal dialysis group (1.22±0.38)mm, the CIMT dates in two groups ofdialysis were significantly higher than that in the control group, P<0.05.3Comparison of the two types of dialysis mode: the levels of TP,Alb,HsCRP, UA,Hcy were higher in hemodialysis group than those inperitonealdialysis group (respectively69.33±4.92g/L vs64.27±6.38g/L,39.51±5.01g/Lvs36.77±4.75g/L,5.94±1.29mg/L vs5.09±1.60mg/L,400.00±54.95umol/Lvs373.04±46.09umol/L,26.48±2.31umol/L vs22.10±3.23umol/L), and hadstatistically significant, P<0.05. The levels of Hb, TC, LDL of thehemodialysis patients were lower than those in the peritoneal dialysis patients,(respectively104.5±14.05vs112.35±12.65g/L,4.19±0.91vs5.07±1.43mmol/L,2.14±0.63vs2.68±0.68mmol/L)，and had statistically significant, P<0.05.4Compared with peritoneal dialysis group, the levels of SBP, DBP ofhemodialysis group were higher, and the levels of SBP had statisticallysignificant. The incidence of cardiovascular disease were respectively35%in hemodialysis group and16.25%in peritoneal dialysis group (P<0.05). RRFin peritoneal dialysis group were better than that in hemodialysis patients.5The leves of ET-1and eNOS in three groups: Compared with thecontrol group, the level of ET-1in hemodialysis group and peritoneal dialysisgroup were higher (respectively16.11±1.24pg/ml,138.92±31.65pg/ml,140.89±29.5pg/ml), and had statistically significant, P<0.05. Compared with thecontrol group, the level of eNOS in hemodialysis group and peritoneal dialysisgroup were lower (respectively14.74±1.60U/ml,12.65±2.36U/ml,12.34±1.60 U/ml), and had statistically significant, P<0.05. Furtherly the ET-1and eNOShad no significant difference between Hemodialysis group and peritonealdialysis groups, P>0.05.6The levels of ET-1and eNOS in the group with/without the cardiov-ascular disease: In with the cardiovascular disease group, the levels of ET-1and eNOS were respectively (163.45±22.58)pg/ml,(11.66±1.99)U/ml. Inwithout cardiovascular disease group, the level of ET-1and eNOS wererespectinvly (133.74±28.68)pg/ml,(12.65±1.77)U/ml. There were significantstatistical on the leves of ET-1and eNOS, P<0.05. While there were higherlevel of ET-1and lower level of eNOS in the with cardiovascular diseasegroup.7Grouped by the dates of carotid intima-media thickness: In the normalcarotid intima-media thickness group the level of ET-1and eNOS wererespectinvly (100.71±9.81)pg/ml,(13.71±1.80)U/ml. In the abnormal Carotidintima-media thickness group the level of ET-1and eNOS were respectinvly(152.61±22.86)pg/ml,(12.04±1.72)U/ml. ET-1, eNOS were significant differ-ences between the two groups, P<0.05.8In the RRF≥1ml/min gr-oup the level of ET-1and eNOS wererespectinvly (100.71±9.81)pg/ml,(13.71±1.80)U/ml. In the RRF<1ml/mingroup the level of ET-1and eNOS were respectinvly(152.61±22.86)pg/ml,(12.04±1.72)U/ml. The RRF≥1ml/min group had a lower ET-1level and ahigher level of eNOS than the RRF<1ml/min group, with statistical signi-ficance, P<0.05.9Correlation analysis: The eNOS were negatively correlated with theduration of dialysis (r=-0.67，p=0.000), TG(r=-0.756，p=0.000), LDL(r=-0.280,p=0.009), Hcy(r=-0.277，p=0.010), UA(r=-0.558，p=0.000), CIMT(r=-0.752，p=0.000), SBP(r=-0.508,p=0.002), DBP(r=-0.530，p,0.000),HsCRP(r=-0.237,p=0.011). The ET-1were positively correlated with the duration of dialysis(r=0.79, p=0.000), TG(r=0.868, p=0.000), Hcy(r=0.246, p=0.023), UA(r=0.69,p=0.000), Ca(r=0.259，p=0.016), P(r=-0.303，p,0.005), SBP(r=0.561，p=0.000),DBP(r=0.518，p=0.000), HsCRP(r=0.418，p=0.000), CIMT(r=0.919，p=0.000). 10Multiple linear regression analysis: Regarding duration of dialysis, TG,LDL, Hcy, UA, CIMT, SBP, DBP, HsCRP as the independent variables, andwith the confounding factors removed, UA, LDL and SBP were theindependent risk factors for eNOS, UA(B=-0.396，P=0.000), LDL(B=-0.307，P=0.000)，SBP(B=-0.319，P=0.001). Regarding duration of dialysis, TG, Hcy,UA, Ca, P, SBP, DBP, HsCRP, CIMT as the independent variables, and withthe confounding factors removed, TG，Hcy and SBP were the independent riskfactors for ET-1, TG (B=13.880,P=0.000), Hcy (B=3.093,P=0.003), SBP (B=2.248,P=0.027).Conclusions:1The levels of eNOS and ET-1were not significantly different betweengroups of peritoneal dialysis patients and hemodialysis patients,indicating thatthere were not significantly different the two sets of dialysis modes onendothelial function in patients with ESRD.2UA，LDL and SBP were the independent risk factors for eNOS. Hcy,TG and SBP were the independent risk factors for ET-1.3Peritoneal dialysis patients had better levels of UA, Hcy and SBP thanthat in hemodialysis,while hemodialysis patients had better levels of TG, LDLthan those in peritoneal dialysis.4Compared to hemodialys group, the incidence of cardiovascular diseasein peritoneal dialysis group was lower.5The RRF of peritoneal dialysis patients was significantly higher thanthat of hemodialysis patients, indicating that peritoneal dialysis can betterprotect the residual renal function compared to hemodialysis. |
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