Carotid atherosclerosis is associated with inflammation, malnutrition and intercellular adhesion molecule-1 in patients on continuous ambulatory peritoneal dialysis

Abstract

Background: Recent evidence suggests that endothelial cell adhesion molecules may participate in the initiation and progression of atherosclerotic vascular damage. The aim of the present report was to investigate serum intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin concentrations and their probable association with atherosclerotic disease in patients on continuous ambulatory peritoneal dialysis (CAPD).

Methods: Sixty-three CAPD patients and 40 age- and sex-matched apparently healthy normotensive controls participated in the study. Atherosclerotic disease in both groups was assessed by measuring the intima-media thickness (IMT) and plaque score of the common carotid arteries using an ultrasound scanner.

Results: Compared with controls, CAPD patients had significantly increased IMT and plaque score values (P<0.001 and P<0.0001, respectively), as well as serum ICAM-1, VCAM-1 and E-selectin concentrations (P<0.0001, P<0.0001 and P<0.05, respectively). In univariate analyses, IMT values were significantly correlated with age, systolic blood pressure (BP), logCRP, fibrinogen, albumin and ICAM-1 levels (P = 0.001, P = 0.04, P = 0.01, P = 0.04, P = 0.02 and P = 0.002, respectively). Multivariate analysis showed that ICAM-1 levels were a strong independent correlate of IMT (P = 0.005). Serum albumin also remained independently associated with IMT values (P = 0.03). Plaque score values were significantly correlated with age, systolic BP and fibrinogen (P = 0.002, P = 0.04 and P = 0.01, respectively). Multivariate analysis showed that fibrinogen concentrations were a significant independent contributor to plaque score values (P = 0.002). Adhesion molecule concentrations did not show any relation with plaque score either on univariate or multivariate analyses.

Conclusions: In CAPD patients, carotid atherosclerosis is associated with markers of inflammation, malnutrition and circulating levels of adhesion molecule ICAM-1. Hypoalbuminaemia and ICAM-1 appear independently related with atherogenesis but the mechanisms supporting these associations remain to be identified.