Low Serum Levels of Vitamin D are Associated with Progression of Subclinical Atherosclerotic Vascular Disease in Peritoneal Dialysis Patients: A Prospective, Multicenter Study

Abstract

Background: The prevalence of subclinical atherosclerosis and the main predictors of progression of this condition in patients undergoing peritoneal dialysis (PD) have been insufficiently investigated. Objectives and Method: Following a prospective, multicenter, observational design, we studied 237 patients who were treated with PD for ≥3 months, without any clinical background of cardiovascular (CV) disease. Our objectives were the following: (1) to investigate the prevalence of subclinical atherosclerosis, as compared to a control group of age- and sex-matched healthy individuals, and (2) to disclose PD technique-related predictors of progression of disease during a 24-month follow-up period. We used vascular ultrasound for characterization of subclinical atherosclerotic disease. Main Results: A total of 123 patients (51.9%) vs. 79 controls (33.5%) presented ≥1 carotid plaque, and 114 patients (48.3%) vs. 72 controls (30.5%) ≥1 femoral plaque, at baseline evaluation (p < 0.0005). Progression of disease, either in clinical or ultrasound (new plaques) terms, affected 62.6% of patients. Multivariate analysis identified age, carotid intima-media thickness, presence of ≥1 carotid plaque, and serum levels of 25OH vitamin D and C-reactive protein (CRP) at baseline as independent correlates of progression of atherosclerotic disease. On the contrary, PD technique-related variables did not show any association with this outcome. Conclusions: Atherosclerotic vascular disease is frequent among asymptomatic patients undergoing PD. Older age, pre-existent disease (assessed by vascular ultrasound), and serum levels of 25OH vitamin D and CRP are independent markers of the progression of this condition. These findings may contribute to improve identification of subpopulations with a high risk of CV events, deserving intensified measures of prevention.

Association of Serum Vitamin D Level and Carotid Atherosclerosis: A Systematic Review and Meta‐analysis

“…By reviewing the full articles, 51 articles were further rejected for the following reasons: (1) data were unavailable to calculate the OR/hazard ratio (eg, quantitative variables); (2) no outcome data of interest were included; and (3) the study was a basic research/review article or not related. Finally, 11 studies were eligible for inclusion in our analysis …”

Carotid intima‐media thickness predicts carotid plaque development: Meta‐analysis of seven studies involving 9341 participants

“…In a subpopulation of the NEFRONA study involving 1553 participants with different stages of chronic kidney disease, cIMT was associated with new plaque progression in dialysis patients . In another subpopulation of the NEFRONA study including 237 patients undergoing peritoneal dialysis, individuals in the median and highest third of baseline cIMT had a higher risk for progression of atherosclerotic disease compared to individuals in the lowest third of baseline cIMT …”

“…45 In another subpopulation of the NEFRONA study including 237 patients undergoing peritoneal dialysis, individuals in the median and highest third of baseline cIMT had a higher risk for progression of atherosclerotic disease compared to individuals in the lowest third of baseline cIMT. 46 In order to predict the genesis of carotid plaques, it is important to study initiation and progression of atherosclerosis. The mechanisms behind the development of atherosclerosis consist of many different facets including inflammation, endothelial dysfunction, oxidation, lipid accumulation, proliferation and migration of vascular smooth muscle cells, which lead to manifestation of atherosclerotic plaques in the vessel walls that can further cause thrombosis and stenosis in human arteries.…”

Effects of parathyroid hormone and vitamin D supplementation on stroke among patients receiving peritoneal dialysis

“…However, it is also recognized that the stroke risk profiles of CAPD patients are slightly different from those of the general population because of the loss of residual renal function, which may contribute to disorders of mineral and bone metabolism, volume overload, irrepressible hypertension, electronic disorder, and treatment with glucose-based dialysis solutions. Commonly, increased serum parathyroid hormone (PTH) levels and vitamin D insufficiency are universal among CAPD patients and are mostly attributed to chronic kidney disease-mineral and bone disorder (CKD-MBD) [8][9][10]. Accumulating evidence has indicated that vitamin D deficiency or insufficiency significantly increased cardiovascular disease (CVD) events among the general or dialysis population [11][12][13][14].…”