THE ASSOCIATION OF DYSLIPIDEMIA WITH INTRAPERITONEAL INFLAMMATION AND PERITONEAL DIALYSIS TECHNIQUE SURVIVAL

The aim of the study was to determine the relationship between the dyslipidemia, intraperitoneal inflammation and peritoneal dialysis (PD) survival. Patients and methods. A total of 40patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis (PD) have been included in a prospective, observational study (average age was 49.3 ± 12.7). All patients were determined the blood lipid spectrum and IL-10, TNF-a, MCP-1 levels in peritoneal dialysis effluent (PDE). PD adequacy indicators evaluated by determining the concentration of urea and creatinine in plasma, urine and dialysate, calculated weekly creatinine clearance (CrCl), dialysis (Kt/ Vd), renal (Kt/ Vr) and total weekly urea clearance (Kt/ V). Results. Dyslipidemia defined as increase of atherogenic lipoprotein fractions and inhibition ofHDL cholesterol was identified in 70% of the PD-patients. LDL cholesterol level and, accordingly, an atherogenic index (AI) were significantly dependent on the duration of PD treatment (R2 = 2.18 ± 0.15 (95% CI 1.87, 2.5), p < 0,0001 and R2 = 2.77 ± 0.27(95% CI 2.2, 3.3), p < 0,0001). The blood levels of total cholesterol, LDL-C and TG in the patients with diabetes were significantly higher compared with the diabetes-free patients (p = 0.007, p = 0.001 andp = 0.02, respectively). Reducing the HDL cholesterol level was associated with high intraperitoneal production of pro-inflammatory mediators TNF-a (r = - 0.53;p = 0.001) and anti-inflammatory IL-10 (r = - 0.783;p <0.0001), whereas hypertriglyceridemia and high VLDL cholesterol are associated with an increase of MCP-1 (r = 0.6;p = 0.0003 and r = 0.55;p = 0.002, respectively). The Cox proportional hazards regression analysis demonstrated the significant effect of VLDL cholesterol, LDL cholesterol and AI on the survival of PD technique survival (x2 = 24.8; p < 0.0001). The results of the Kaplan–Meier analysis and log-rank test also identified that there was a significant difference in the cumulative technical survival rate between the patients with AI level < 3.5 and > 3.5 (log-rank test: x2 = 19.8, P = 0.001. Conclusions. Our results can be considered dyslipidemia in PD-patients not only as a traditional risk factor for CVD, but also as a predictor of chronic intraperitoneal inflammation and decrease of PD technical survival.