Impact of Peritoneal Dialysis Treatment on Arterial Stiffness and Vascular Changes in Diabetic Type 2 and Nondiabetic Patients with End-Stage Renal Disease
Diabetes mellitus (DM) is the leading cause of the end-stage renal disease (ESRD). Vascular diseases are the most common cause of morbidity and mortality in the chronic kidney disease. The aim of this study was to analyze the impact of peritoneal dialysis (PD) treatment on morphologic and hemodynamic vascular parameters of carotid arteries in diabetic type 2 and nondiabetic patients with ESRD during the period of one year after the start of PD treatment using ultrasonography of carotid arteries and their relation on uremia and PD inherent factors. Mean intima-media thickness, plaque score, peak systolic velocity, end-diastolic velocity, and carotid diameter significantly decreased 12 months after PD treatment start in both groups. Significant reduction in median serum endothelin-1 concentration after 12 months on PD treatment was observed in the group of patients with DM (7.6–5.9？pg/mL) and also in group of patients without DM (3.6–3.3？pg/mL). Also median nitric oxide concentration significantly increased after 12 months on PD compared to baseline levels both in patients with DM (25.0–34.3？μmol/L) as was observed in patients without DM (49.6–56.5？μmol/L). PD treatment, with the regulation of these vasoactive molecules and other vascular risk factors, significantly contributes to vascular remodeling, especially in DM patients. 1. Introduction Diabetes mellitus (DM) is the leading cause of the end-stage renal disease (ESRD) in many countries of the world. In Bosnia and Herzegovina, 17.3% of dialysis patients have primarily diabetes mellitus, while in Korea as many as 44.9% dialysis patients developed ESRD as a consequence of diabetes nephropathy [1]. Although the survival rate in DM patients with ESRD partially improved, it is still significantly lower than that in general population [2]. The results of NECOSAD study showed that survival in diabetic patients with ESRD was worse compared to nondiabetic patients and that diabetes mellitus has a very strong impact on survival even if it is not the primary cause of ESRD [3]. Risk factors for cardiovascular death in these patients include those that affect the general population as well as those related to end-stage renal disease and those that are specific to peritoneal dialysis. The development of over hydration after loss of residual renal function (RRF) is probably the most important cardiovascular risk factor specific to peritoneal dialysis. The high glucose load associated with peritoneal dialysis may lead to insulin resistance and to the development of an atherogenic lipid profile. The presence of
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