Background: A poor nutritional state is associated with an increased risk of cardiovascular events in end-stage renal disease. It is unclear whether malnutrition itself can induce cardiovascular disease (CVD). We examined the impact of nutritional status on patients’ arterial stiffness in peritoneal dialysis (PD) patients. Methods: We prospectively enrolled 121 stable PD patients and evaluated them at baseline and 1 year later. According to patients’ Subjective Global Assessment (SGA) changes from baseline to the end, patients were divided into four groups: group 1, SGA from A to B; group 2, SGA remained A, group 3, SGA changed from B to A, and group 4, SGA remained B. Arterial stiffness was assessed by pulse-wave velocity (PWV). Results: At baseline, PWV in well-nourished patients were lower than malnourished patients (p < 0.05). One year later, in group 1, as compared with baseline, PWV increased significantly (p < 0.001) whereas handgrip strength (HGS), daily dietary protein intake and dietary energy intake decreased significantly. In group 3, PWV decreased significantly (p < 0.05) whereas HGS and ALB increased significantly. In groups 1 and 3, lgCRP level remained unchanged. Conclusion: There was a closely longitudinal association between nutritional status and arterial stiffness in PD patients, suggesting a possible impact of nutritional status on arterial function.

1.
Cianciaruso B, Brunori G, Kopple JD, Traverso G, Panarello G, Enia G, Strippoli P, De Vecchi A, Querques M, Viglino G: Cross-sectional comparison of malnutrition in continuous ambulatory peritoneal dialysis and hemodialysis patients. Am J Kidney Dis 1995;26:475–486.
2.
Young GA, Kopple JD, Lindholm B, Vonesh EF, De Vecchi A, Scalamogna A, Castelnova C, Oreopoulos DG, Anderson GH, Bergstrom J: Nutritional assessment of continuous ambulatory peritoneal dialysis patients: an international study. Am J Kidney Dis 1991;17:462–471.
3.
Canada-USA (CANUSA) Peritoneal Dialysis Study Group: Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol 1996;7:198–207.
4.
Chung SH, Lindholm B, Lee HB: Influence of initial nutritional status on continuous ambulatory peritoneal dialysis patient survival. Perit Dial Int 2000;20:19–26.
5.
Parfrey PS, Foley RN: The clinical epidemiology of cardiac disease in chronic renal failure. J Am Soc Nephrol 1999;10:1606–1615.
6.
Cooper BA, Penne EL, Bartlett LH, Pollock CA: Protein malnutrition and hypoalbuminemia as predictors of vascular events and mortality in ESRD. Am J Kidney Dis 2004;43:61–66.
7.
Fung F, Sherrard DJ, Gillen DL, Wong C, Kestenbaum B, Seliger S, Ball A, Stehman-Breen C: Increased risk for cardiovascular mortality among malnourished end-stage renal disease patients. Am J Kidney Dis 2002;40:307–314.
8.
Zhe XW, Tian XK, Chen W, Guo LJ, Gu Y, Chen HM, Tang LJ, Wang T: Association between arterial stiffness and peritoneal fluid kinetics. Am J Nephrol 2008;28:128–132.
9.
Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM: Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation 2001;103:987–992.
10.
Gu Y, Cheng LT, Chen HM, Sun XY, Tang LJ, Guo LJ, Axelsson J, Wang T: Strong association between nutritional markers and arterial stiffness in continuous ambulatory peritoneal dialysis patients. Blood Purif 2008;26:340–346.
11.
Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac AM, Target R, Levy BI: Assessment of arterial distensibility by automatic pulse-wave velocity measurement. Validation and clinical application studies. Hypertension 1995;26:485–490.
12.
Cheng LT, Tang W, Wang T: Strong association between volume status and nutritional status in peritoneal dialysis patients. Am J Kidney Dis 2005;45:891–902.
13.
Kopple JD: National Kidney Foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis 2001;37:S66–S70.
14.
Nolph KD, Moore HL, Prowant B, Meyer M, Twardowski ZJ, Khanna R, Ponferrada L, Keshaviah P: Cross-sectional assessment of weekly urea and creatinine clearances and indices of nutrition in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 1993;13:178–183.
15.
Watson PE, Watson ID, Batt RD: Total body water volumes for adult males and females estimated from simple anthropometric measurements. Am J Clin Nutr 1980;33:27–39.
16.
Van Olden RW, Krediet RT, Struijk DG, Arisz L: Measurement of residual renal function in patients treated with continuous ambulatory peritoneal dialysis. J Am Soc Nephrol 1996;7:745–750.
17.
Stenvinkel P, Heimburger O, Lindholm B, Kaysen GA, Bergstrom J: Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant 2000;15:953–960.
18.
Ter Avest E, Stalenhoef AF, de Graaf J: What is the role of non-invasive measurements of atherosclerosis in individual cardiovascular risk prediction? Clin Sci (Lond) 2007;112:507–516.
19.
Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM: Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999;99:2434–2439.
20.
Wang AY-M, Sea MM-M, Ho ZS-Y, Lui SF, Li PKT, Woo J: Evaluation of handgrip strength as a nutritional marker and prognostic indicator in peritoneal dialysis patients. Am J Clin Nutr 2005;81:79–86.
21.
Stenvinkel P, Heimburger O, Lindholm B: Wasting, but not malnutrition, predicts cardiovascular mortality in end-stage renal disease. Nephrol Dial Transplant 2004;19:2181–2183.
22.
Kuzniar J, Porazko T, Klinger M: Relationship between fetuin-A concentration, elevated levels of inflammatory markers, and arterial wall stiffness in end-stage kidney disease. J Ren Nutr 2008;18:83–86.
23.
Kato A, Odamaki M, Ishida J, Hishida A: Association of high-molecular-weight to total adiponectin ratio with pulse-wave velocity in hemodialysis patients. Nephron Clin Pract 2008;109:c18–c24.
24.
Cockcroft JR: Exploring vascular benefits of endothelium-derived nitric oxide. Am J Hypertens 2005;18:177S–183S.
25.
Booth AD, Wallace S, McEniery CM, Yasmin, Brown J, Jayne DR, Wilkinson IB: Inflammation and arterial stiffness in systemic vasculitis: a model of vascular inflammation. Arthritis Rheum 2004;50:581–588.
26.
Brunini TMC, Mendes-Ribeiro AC, Ellory JC, Mann GE: Platelet nitric oxide synthesis in uremia and malnutrition: A role for L-arginine supplementation in vascular protection? Cardiovasc Res 2007;73:359–367.
27.
Ritz E: Why are lipids not predictive of cardiovascular death in the dialysis patient? Miner Electrolyte Metab 1996;22:9–12.
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