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Perit Dial Int 27(Supplement_3): 12- 2007
© 2007 International Society for Peritoneal Dialysis
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Cardiovascular Disease

Metabolic Syndrome Is Associated with Increased Plasma Levels of Monocyte Chemoattractant Protein in Dialysis Patients

P.C. Fortes, J.G. Mendes, A. Stinghen, M.C. Riella and R. Pecoits-Filho

Pontificia Universidade Católica do Paraná, Curitiba, Parana, Brazil

Objective: Metabolic syndrome (MetS) is associated with increased cardiovascular risk in general population, but data in the dialysis population are lacking. Monocyte chemoattractant protein (MCP-1) is a chemokine involved in the early stages of atherogenesis that has been used as a marker of endothelial dysfunction. The aim of the study was to analyze the association between MetS components and MCP-1 plasma levels in dialysis patients (pts). Methods: Clinically stable prevalent hemodialysis (HD) and peritoneal dialysis (PD) pts were included in the study. All PD pts were on glucose-based solutions. MetS parameters included fasting glucose, triglycerides, HDL, and BMI. We also measured the HOMA index, total cholesterol, LDL, and uric acid. MCP-1 levels were measured by ELISA. Results: We studied 139 pts, 71 in HD and 68 in PD, with a mean age of 55±13 years, 42% diabetics, and 52% males. The plasma MCP-1 levels were 228±86 pg/mL. The prevalence of MetS was significantly higher in PD pts (54%) when compared to HD (30%, p<0.005). In a univariate analysis, MCP-1 levels were significantly higher in pts with MetS, compared to those without (p<0.005). Pts on PD presented higher levels of MCP-1 when compared to HD pts, even when adjusted for age, gender, and diabetes (p<0.0005). There were significant correlations between MCP-1 and fasting glucose (rho=0.21, p<0.05), HbA1c (rho=0.20, p<0.05), HOMA index (rho=0.24, p<0.005), total cholesterol (rho=0.27, p<0.005), LDL (rho=0.24, p<0.005), triglycerides (rho=0.18, p<0.05), abdominal waist (rho=0.26, p<0.005), BMI (rho=0.27, p<0.005), fibrinogen (rho=0.18, p<0.05), and uric acid (rho=0.32, p<0.0005). In a multivariate analysis, the most important determinant of MCP-1 levels was PD as the type of dialysis (R2=0.36, p<0.0001). Conclusions: Several components of the MetS (which is more prevalent in PD) are associated with high levels of MCP-1. Moreover, PD is an important determinant of MCP-1 levels. These results suggest that MetS could be involved in the accelerated atherosclerosis observed in dialysis (particularly PD) in a process mediated by the expression of MCP-1. The effects of glucose-sparing solutions on this metabolic/immune response deserve future studies.






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