Lipidic Profiles of Patients Starting Peritoneal Dialysis Suggest an Increased Cardiovascular Risk Beyond Classical Dyslipidemia Biomarkers

Abstract Background. Lipids are molecules that constitute a fundamental part of the plasma. Chronic kidney disease (CKD) produces profound changes in lipid metabolism, and associated lipid disorders, in turn, contribute to the progression of CKD. Patients on peritoneal dialysis (PD) have more atherogenic lipid profiles than non-dialysis-dependent CKD patients. Methods. Single-center prospective observational study of a cohort of CKD patients who started renal replacement therapy with continuous ambulatory peritoneal dialysis. The differences in the lipid profile and analytical variables before and six months after the start of peritoneal dialysis were analyzed. Samples were analyzed on an Ultra-Performance Liquid Chromatography system. Results. Thirty-nine patients were enrolled in this study. Their mean age was 57.9 ± 16.3 years. A total of 157 endogenous lipid species of 11 lipid subclasses were identified. There were significant increases in total free fatty acids (p< 0.05), diacylglycerides (p <0.01), triacylglycerides, (p <0.01), phosphatidylcholines (p <0.01), phosphatidylethanolamines (p <0.01), ceramides (p <0.01), sphingomyelins (p <0.01), and cholesterol esters (p<0.01) from baseline to 6 months. However, there were no differences in the classical lipid markers, neither lysophosphatidylcholines, monoacylglycerides, and sphingosine levels. Conclusions. Patients on PD present changes in the lipidomic profile beyond the classic markers of dyslipidemia, that suggest an increased cardiovascular risk in them.

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Risk Factors for Cardiovascular Disease in Patients Undergoing Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080702702s35 ◽

2007 ◽

Vol 27 (2_suppl) ◽

pp. 205-209 ◽

Cited By ~ 3

Author(s):

Elvia García–López ◽

Juan J. Carrero ◽

Mohamed E. Suliman ◽

Bengt Lindholm ◽

Peter Stenvinkel

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Cardiovascular Risk ◽

Pressure Control ◽

High Cardiovascular Risk ◽

Cardiovascular Research ◽

Factors Associated ◽

Glycation End Products ◽

Anemia Management ◽

Altered Lipid

Patients on peritoneal dialysis (PD) are at high cardiovascular risk. Although some risk factors are unmodifiable (for example, age, sex, genetics), others are exacerbated in the unfriendly uremic milieu (inflammation, oxidative stress, mineral disturbances) or contribute per se to kidney disease and cardiovascular progression (diabetes mellitus, hypertension). Moreover, several factors associated with PD therapy may both increase (by altered lipid profile, hyperinsulinemia, and formation of advanced glycation end-products) and decrease (by better blood pressure control and anemia management) cardiovascular risk. The present review discusses recent findings and therapy trends in cardiovascular research on the PD population, with emphasis on the roles of inflammation, insulin resistance, homocysteinemia, dyslipidemia, vascular calcification, and genetics/epigenetics.

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Elevated Serum Trimethylamine N-Oxide Levels Are Associated with Mortality in Male Patients on Peritoneal Dialysis

Blood Purification ◽

10.1159/000512962 ◽

2021 ◽

pp. 1-11

Author(s):

Dongying Fu ◽

Jiani Shen ◽

Wei Li ◽

Yating Wang ◽

Zhong Zhong ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Proportional Hazards ◽

Elevated Serum ◽

Ultra Performance Liquid Chromatography ◽

Cox Proportional Hazards ◽

Serum Samples ◽

Entire Cohort ◽

Increased Risk ◽

All Cause Mortality ◽

Male Patients

Background: Elevated levels of serum trimethylamine N-oxide (TMAO) have been previously linked to adverse cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the clinical significance of serum TMAO levels in patients treated with peritoneal dialysis (PD) is unclear. Methods: A total of 1,032 PD patients with stored serum samples at baseline were enrolled in this prospective study. Serum concentrations of TMAO were quantified by ultra-performance liquid chromatography-tandem mass spectrometry. Cox proportional hazards and competing-risk regression models were performed to examine the association of TMAO levels with all-cause and CV mortality. Results: The median level of serum TMAO in our study population was 34.5 (interquartile range (IQR), 19.8–61.0) μM. During a median follow-up of 63.7 months (IQR, 43.9–87.2), 245 (24%) patients died, with 129 (53%) deaths resulting from CV disease. In the entire cohort, we observed an association between elevated serum TMAO levels and all-cause mortality (adjusted subdistributional hazard ratio [SHR], 1.22; 95% confidence interval [95% CI], 1.01–1.48; p = 0.039) but not CV mortality. Further analysis revealed such association differed by sex; the elevation of serum TMAO levels was independently associated with increased risk of both all-cause (SHR, 1.37; 95% CI, 1.07–1.76; p = 0.013) and CV mortality (SHR, 1.41; 95% CI, 1.02–1.94; p = 0.038) in men but not in women. Conclusions: Higher serum TMAO levels were independently associated with all-cause and CV mortality in male patients treated with PD.

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Comparison of outcomes between emergent-start and planned-start peritoneal dialysis in incident ESRD patients: a prospective observational study

BMC Nephrology ◽

10.1186/s12882-017-0764-6 ◽

2017 ◽

Vol 18 (1) ◽

Cited By ~ 9

Author(s):

Wen-Yi Li ◽

Yi-Cheng Wang ◽

Shang-Jyh Hwang ◽

Shih-Hua Lin ◽

Kwan-Dun Wu ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Observational Study ◽

Prospective Observational Study ◽

Esrd Patients

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Cardiovascular risk factors in hemodialysis and peritoneal dialysis patients

Scandinavian Journal of Clinical and Laboratory Investigation ◽

10.1080/00365510500375271 ◽

2005 ◽

Vol 65 (8) ◽

pp. 739-745 ◽

Cited By ~ 10

Author(s):

F. M. Yilmaz ◽

G. Yilmaz ◽

M. Duranay ◽

H. Parpucu ◽

M. Şeneş ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Dialysis Patients

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The Potential Cardiovascular Benefits of Low-Glucose Degradation Product, Biocompatible Peritoneal Dialysis Fluids: A Review of the Literature

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00228 ◽

2017 ◽

Vol 37 (4) ◽

pp. 375-383 ◽

Cited By ~ 7

Author(s):

Charlotte E. Grantham ◽

Katherine L. Hull ◽

Matthew P.M. Graham-Brown ◽

Daniel S. March ◽

James O. Burton

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Cardiovascular Risk ◽

Interstitial Fibrosis ◽

Degradation Products ◽

Controlled Trial ◽

Membrane Integrity ◽

Left Ventricular ◽

Stage Renal Disease ◽

End Stage

Cardiovascular mortality in the end-stage renal disease (ESRD) population remains the leading cause of death. Targeting traditional cardiovascular risk factors has proven unsuccessful in this patient population, and therefore attention has turned to risk factors related to chronic kidney disease (CKD). The toxicity of high-glucose peritoneal dialysis (PD) solutions has been well documented. The breakdown of glucose into glucose degradation products (GDP) and advanced glycation end-products (AGE) has the ability to alter cell viability and cause premature apoptosis and is strongly correlated with interstitial fibrosis and microvascular sclerosis. Biocompatible solutions have been introduced to combat the hostile milieu to which PD patients are exposed.Given the considerable cardiovascular burden for PD patients, little is known about the cardiovascular impact the new biocompatible solutions may have. This review analyzes the existing literature regarding the mechanisms through which low-GDP solutions may modulate cardiovascular risk. Interventions using low-GDP solutions have provided encouraging changes in structural cardiovascular measures such as left ventricular mass (LVM), although metabolic changes from reduced GDP and AGE exposure yield inconclusive results on vascular remodelling. It is thought that the local effects of reduced glucose exposure may improve membrane integrity and therefore fluid status. Further research in the form of a robust randomized controlled trial should be carried out to assess the true extent of the cardiovascular benefits these biocompatible solutions may hold.

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Peritoneal dialysis assists residual renal function to maintain glucose tolerance: a prospective observational study

Renal Replacement Therapy ◽

10.1186/s41100-016-0072-9 ◽

2016 ◽

Vol 2 (1) ◽

Author(s):

Naoki Washida ◽

Takahiro Kasai ◽

Kozi Hosoya ◽

Hirobumi Tokuyama ◽

Shu Wakino ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Observational Study ◽

Glucose Tolerance ◽

Prospective Observational Study ◽

Residual Renal Function

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Alteration in the Cerebrospinal Fluid Lipidome in Parkinson’s Disease: A Post-Mortem Pilot Study

Biomedicines ◽

10.3390/biomedicines9050491 ◽

2021 ◽

Vol 9 (5) ◽

pp. 491

Author(s):

Joaquín Fernández-Irigoyen ◽

Paz Cartas-Cejudo ◽

Marta Iruarrizaga-Lejarreta ◽

Enrique Santamaría

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cerebrospinal Fluid ◽

Ultra Performance Liquid Chromatography ◽

Small Population ◽

Control Group ◽

Post Mortem ◽

Cellular Models ◽

Flight Mass Spectrometry ◽

Lipid Species

Lipid metabolism is clearly associated to Parkinson’s disease (PD). Although lipid homeostasis has been widely studied in multiple animal and cellular models, as well as in blood derived from PD individuals, the cerebrospinal fluid (CSF) lipidomic profile in PD remains largely unexplored. In this study, we characterized the post-mortem CSF lipidomic imbalance between neurologically intact controls (n = 10) and PD subjects (n = 20). The combination of dual extraction with ultra-performance liquid chromatography-electrospray ionization quadrupole-time-of-flight mass spectrometry (UPLC-ESI-qToF-MS/MS) allowed for the monitoring of 257 lipid species across all samples. Complementary multivariate and univariate data analysis identified that glycerolipids (mono-, di-, and triacylglycerides), saturated and mono/polyunsaturated fatty acids, primary fatty amides, glycerophospholipids (phosphatidylcholines, phosphatidylethanolamines), sphingolipids (ceramides, sphingomyelins), N-acylethanolamines and sterol lipids (cholesteryl esters, steroids) were significantly increased in the CSF of PD compared to the control group. Interestingly, CSF lipid dyshomeostasis differed depending on neuropathological staging and disease duration. These results, despite the limitation of being obtained in a small population, suggest extensive CSF lipid remodeling in PD, shedding new light on the deployment of CSF lipidomics as a promising tool to identify potential lipid markers as well as discriminatory lipid species between PD and other atypical parkinsonisms.

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