The Relationship between Oxidative Stress and Coronary Artery Calcification in Patients Undergoing Peritoneal Dialysis or Hemodialysis

Abstract

Vascular calcification and increased oxidative stress are commonly seen in patients with end-stage renal disease (ESRD). Nitrotyrosine is one of the end products of nitric oxide metabolism and is accepted as an indicator of oxidative stress. Nitrotyrosine levels have been found to be high in ESRD patients. The aim of our study is to investigate the relation between coronary artery calcification and oxidative stress in peritoneal dialysis (PD) and hemodialysis (HD) patients. 46 PD and 34 HD patients are included in the study. Coronary artery calcification scoring (CACS) is made by multi slice computed tomography. Patients are divided into 4 groups according to their CACS values as Group 1 (CACS: 0), Group 2 (CACS:1-99), Group 3 (CACS:100-399) and Group 4 (CACS: ≥400). Serum nitrotyrosine levels were measured. Nitrotyrosine levels were significantly increased in HD patients compared to PD patients. Nitrotyrosine levels were found to be elevated in accordance with increased CACS in PD patients. However, we could not find this relationship in HD patients. There might be an important relationship between CACS and oxidative stress in PD patients.

Keywords

• Hemodialysis, peritoneal dialysis, oxidative stress, vascular calcification

The Relationship between Oxidative Stress and Coronary Artery Calcification in Patients Undergoing Peritoneal Dialysis or Hemodialysis

Abstract

Son dönem böbrek yetersizliği (SDBY) gelişen hastalarda vasküler kalsifikasyon (VK) ve oksidatif stres yaygın olarak gözlenmektedir. SDBY’li hastalarda oksidatif stres belirteci olan nitrotirozin düzeyinin yüksek olduğu tespit edilmiştir. Çalışmamızın amacı periton diyaliz (PD) ve hemodiyaliz (HD) hastalarında koroner arter kalsifikasyonu ile oksidatif stres arasındaki ilişkiyi incelemektir. Çalışmamıza 46 PD ve 34 HD hastası alınmıştır. Hastalara multi slice bilgisayarlı tomografi ile koroner arter kalsiyum skorlaması (KAKS) yapıldı. KAKS değerlerine göre hastalar Grup 1 (KAKS 0), Grup 2 , Grup 3 ve Grup 4 (KAKS: ≥400) olmak üzere 4 gruba ayrıldı. Serumda nitrotirozin düzeyleri ölçüldü. PD hastalarıyla kıyaslandığında, HD hastalarının nitrotirozin düzeyi anlamlı olarak yüksekti. PD ve HD hastaları KAKS göre gruplara ayrıldığında PD hastalarında KAKS arttığında nitrotirozin düzeyi de anlamlı olarak artmaktaydı, halbuki bu ilişki HD hastalarında tespit edilemedi.PD hastalarında KAKS ile oksidatif stres arasında anlamlı bir ilişki mevcuttur

Keywords

• Hemodiyaliz, periton diyalizi, oksidatif stres, vasküler kalsifikasyonu

References

1. Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32: 112–9.
2. Derici U, El Nahas AM. Vascular calcifications in uremia: old concepts and new insights. Semin Dial 2006; 19: 60–8.
3. Shao JS, Cai J, Towler DA. Molecular mechanisms of vascular calcification: lessons learned from the aorta. Arterioscler Thromb Vasc Biol 2006; 26: 1423–30.
4. Guilgen G, Werneck ML, de Noronha L, Martins AP, Varela AM, Nakao LS, et al. Increased calcification and protein nitration in arteries of chronic kidney disease patients. Blood Purif 2011; 32: 296–302.
5. Proudfoot D, Skepper JN, Shanahan CM, Weissberg PL. Calcification of human vascular cells in vitro is correlated with high levels of matrix Gla protein and low levels of osteopontin expression. Arterioscler Thromb Vasc Biol 1998; 18: 379–88.
6. Ross R. Atherosclerosis an inflammatory disease. N Engl J Med 1999; 340: 115–26.
7. K Taki, F Takayama, Y Tsuruta, T Niwa. Oxidative stress, advanced glycation end product, and coronary artery calcification in hemodialysis patients. Kidney International 2006; 70: 218–24.
8. Raggi P, Boulay A, Chasan-Taber S et al. Cardiac calcification in adult hemodialysis patients. A link between endstage renal disease and cardiovascular disease? J Am Coll Cardiol 2002; 39: 695–701.

9. Turkmen K, Tonbul HZ. Vascular calcification in chronic renal failure. Turkish Nephr Dialysis Transplant J 2010; 19: 82–7.
10. Namiduru ES, Tarakcioglu M, Tiryaki O, Usalan C. Evaluation of oxidative and nitrosative stress in hemodialysis patients. Minerva Med 2010; 101: 305–10.
11. Massy ZA, Borderie D, Nguyen-Khoa T, Drueke TB, Ekindjian OG, Lacour B. Increased plasma S-nitrosothiol levels in chronic haemodialysis patients. Nephrol Dial Transplant 2003; 18: 153–7.
12. Koleganova N, Piecha G, Ritz E, et al. Arterial calcification in patients with chronic kidney disease. Nephrol Dial Transplant 2009; 24: 2488–96.
13. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990; 15: 827–32.
14. Loscalzo J. Nitric oxide insufficiency, platelet activation, and arterial thrombosis. Circ Res 2001; 88: 756–62.
15. Canivet E, Lavaud S, Wong T, Guenounou M, Willemin JC, Potron G, et al. Cuprophane but not synthetic membrane induces increases in serum tumor necrosis factor-alpha levels during hemodialysis. Am J Kidney Dis 1994; 23: 41–6.
16. Hye In Kim, Won Suk An. Comparison of Fetuin-A, Vitamin D, Monounsaturated Fatty Acid, and Vascular Calcification on Plain Radiography Between Dialysis Modalities. IJKD 2013; 7: 453-60.
17. Turkmen K, Ozcicek F, Ozcicek A, Akbas EM, Erdur FM, Tonbul HZ. The relationship between neutrophil-to-lymphocyte ratio and vascular calcification in end-stage renal disease patients. Hemodial Int 2014; 18:47–53.