Association Of Cardiovascular Risk Factors With Nutritional Status And Renal Function In Peritoneal Dialysis Patients

Objective: Chronic kidney disease(CKD)is a global health problem.Cardiovascular death is the most common cause of death in chronic kidney disease.In recent years,several evidences proved that dyslipidemia and inflammation may be the independent risk factors of CVD in CKD patients,especially for continuous ambulatory peritoneal dialysis(CAPD)patients.Long-term use of high-sugar dialysis fluids in CAPD patients may cause dyslipidemia and peritonitis.Meanwhile,large amounts of protein and amino acids are lost during dialysis,which resulting in malnutrition.Malnutrition is not only closely related to factors such as inflammation and renal function,but also a risk factor that affects the quality of life and survival rate of patients with CAPD.In addition,the risk of trace element imbalance in CAPD patients is more serious than the general population,and inflammation may be closely related to the abnormal metabolism of trace elements in CAPD patients.However,limited study has been reported on this field,and the results are controversial.Therefore,our study aimed to investigate the relationship between the two risk factors of CVD and nutritional status as well as renal function.Moreover,we further explored the relationship between inflammation levels and abnormal metabolism of trace elements in CAPD patients.Methods: Part 1: According to the criteria: male HDL-C < 1.03 mmol/L(40 mg/d L);female HDL-C < 1.29 mmol/L(50 mg/d L),the patients were divided into high-level HDL-C group(79 patients)and low-level group(75 patients).Part 2: 70 CAPD patients who both had blood samples and clinical data and met the inclusion criteria were enrolled.According to the cut point(1 mg/L)of hs-CRP concentration,participants were divided into high-level inflammation group(35 patients)and low-level group(35 patients).Student t test,Mann-Whitney U rank test for continuous variables,Chi-square tests for categorical variables were used to compare the baseline characteristics,nutritional status and renal function indicators of study participants.Meanwhile,the Spearman correlation analysis were applied to evaluate the associations of relevant indicators with HDL-C concentrations and hs-CRP concentrations.Logistic regression analysis was used evaluate the association between hs-CRP and serum copper concentrations.Results: Part 1:(1)Compared with the low-level HDL-C group,TG,hs-CRP,BMI,and uric acid were higher in the high-level group,while TC and LDL-C were lower;(2)In addition,HDL-C concentration was negatively correlated with TG,uric acid,and hs-CRP,while positively correlated with BMI,TC,and LDL-C(P < 0.05 for all).Part 2:(1)Compared with the low-level inflammation group,TG and serum Cu were higher in the high-inflammation group,but the levels of HDL-C and prealbumin were lower;(2)There was a negative correlation between hs-CRP concentration and prealbumin.HDL-C was positively correlated with TG(P < 0.05 for all).(3)Comparing the highest with the lowest quartiles of serum copper,the multivariable adjusted ORs were 7.65(1.11-52.46)for high-inflammation.Each SD of serum copper was associated with 2.39(1.21-4.72)increments in ORs of high-inflammation.Conclusions: 1.The level of HDL-C in CAPD patients is closely related to the residual renal function and inflammation.The lower HDL-C level may be unfavorable to the prognosis of CAPD patients.2.In CAPD patients,inflammation may be closely related to malnutrition.At the same time,trace element Cu levels in patients with CAPD may be factors that affect the inflammation.