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Determinants of the Change in Arterial Stiffness in Peritoneal Dialysis Patients. Determinants of the Change in Arterial Stiffness in Peritoneal Dialysis Patients. （腹膜透析患者における動脈硬化進行因子：腹膜透析開始後の横断的もしくは経時的検討から） 中東, 三聖 ナカヒガシ, ミツタカ Nakahigashi, Mitsutaka Tsukaguchi, Hiroyasu Morimoto, Satoshi Nakano, Chikara Ueda, Hiroko Someya, Kazunori Kusabe, Makiko Kikuchi, Sanae Imada, Takanobu Shiojima, Ichiro 平成29年度 Arterial stiffness is an important risk factor for cardiovascular disease (CVD) in patients with end-stage renal failure. However, little is known about the factors that contribute to arterial rigidity in peritoneal dialysis (PD) patients. The aim of this study was to define the pattern and determinants of the longitudinal change in arterial stiffness after PD initiation.Arterial stiffening was estimated for 46 PD patients by using brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (cIMT). The cross-sectional relationship between the arterial markers and their clinical determinants was studied. The longitudinal effects of blood pressure (BP), body fluid status, and glucose were studied over the two years after initiating PD.Multivariate analysis showed that higher baPWV was associated positively with urinary protein excretion (P < 0.001), systolic BP (P = 0.001), and hemoglobin A1c (P = 0.003). In contrast, increased cIMT correlated with smoking (P = 0.004) and hypoalbuminemia (P = 0.04), suggesting that endothelial dysfunction is implicated in the atherogenic process. Neither cIMT nor baPWV correlated significantly with other PD-related covariates of volume overload, peritoneal solute transport, kidney function, and C-reactive protein. Longitudinal observation demonstrated that BP had a greater influence on baPWV changes than hyperglycemia or fluid status.Our study indicates that 1) baPWV represent an arterial marker that integrates multifactorial interaction between modifiable variables including BP and plasma glucose; and 2) intervention aimed at controlling BP as well as nutritional conditions (glucose and albumin) may reduce CVD risk in PD patients. 2017-12-12 eng thesis https://kmu.repo.nii.ac.jp/records/117 International heart journal International heart journal 58 6 915 925 課博第1008号 博士（医学） 2017-09-26 関西医科大学 https://kmu.repo.nii.ac.jp/record/117/files/甲1008　論文要旨（要約）.pdf application/pdf 213.0 kB 2020-08-24 https://kmu.repo.nii.ac.jp/record/117/files/甲1008　審査結果要旨.pdf application/pdf 82.8 kB 2020-08-24