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Articles by A. Y. M Wang
Total Records ( 2 ) for A. Y. M Wang
  A. Y. M Wang , C. W. K Lam , M Wang , I. H. S Chan , S. F Lui and J. E. Sanderson

Background and objectives: Residual renal function (RRF) predicts survival and shows an important inverse relation with cardiac hypertrophy in peritoneal dialysis (PD) patients. We hypothesized that valvular calcification and the calcification milieu may be part of the process linking loss of RRF and cardiac hypertrophy.

Design, setting, participants, & measurements: A cross-sectional study was conducted by performing two-dimensional echocardiography on 230 PD patients to assess valvular calcification and left ventricular (LV) mass and collecting 24-h urine for estimation of RRF.

Results: Patients having valvular calcification had lower RRF than those without. Patients with no RRF showed higher calcium-phosphorus product (Ca x P) and C-reactive protein (CRP). Using multiple logistic regression analysis, every 1-ml/min per 1.73 m2 increase in residual GFR was associated with a 28% reduction in the risk for valvular calcification. The association was lost after additional adjustment for Ca x P and CRP. Using multiple linear regression analysis, loss of RRF showed significant association with increased LV mass index, but this association was lost after additional adjustment for CRP, Ca x P, and valvular calcification. Patients with all three calcification risk factors, namely inflammation, high CaxP, and no RRF, showed the highest prevalence of valvular calcification and had the most severe cardiac hypertrophy.

Conclusions: The association among loss of RRF, valvular calcification, and cardiac hypertrophy was closely linked to increased inflammation and high Ca x P in PD patients. These data suggest that valvular calcification and the calcification milieu are part of the processes linking loss of RRF and worsening cardiac hypertrophy in PD.

  A. Y. M Wang , C. W. K Lam , M Wang , I. H. S Chan , S. F Lui , Y Zhang and J. E. Sanderson

Background. N-terminal-pro-brain natriuretic peptide, cardiac troponin T (cTnT) and high sensitivity C-reactive protein (hs-CRP) have been shown to predict mortality and cardiovascular outcomes in end-stage renal disease patients. However, it is not known which biomarkers have the strongest diagnostic potential for left ventricular (LV) abnormalities in chronic peritoneal dialysis (PD) patients, nor whether residual renal function may confound the diagnostic potential of these biomarkers.

Methods. Two hundred and thirty chronic PD patients underwent two-dimensional echocardiography to determine LV hypertrophy and ejection fraction and had simultaneous measurement of serum NT-pro-BNP, cTnT and hs-CRP.

Results. A significant gain in predictive power was observed when NT-pro-BNP or cTnT but not hs-CRP was included in the multivariable logistic regression models for severe LV hypertrophy (defined as LV mass index ≥ upper tertile, 247.8 g/m2) and systolic dysfunction (defined as ejection fraction ≤45%). Using ROC curve analysis, NT-pro-BNP had the highest diagnostic value for severe LV hypertrophy and systolic dysfunction compared to cTnT and hs-CRP, irrespective of residual renal function. An analysis based on the best cut-off threshold showed that NT-pro-BNP and cTnT had a negative predictive value of 87.1% and 92.6% for severe LV hypertrophy and 95.4% and 93.2% for systolic dysfunction, respectively. Furthermore, the best cut-off threshold of NT-pro-BNP and cTnT for excluding severe LV hypertrophy and systolic dysfunction was nearly 3-fold higher in anuric patients than in patients with residual renal function.

Conclusions. Serum NT-pro-BNP appeared most useful in excluding systolic dysfunction in chronic PD patients followed by cTnT. hs-CRP was not useful in this regard. Residual renal function confounded the interpretation of these biomarkers and reduced their predictive power. A nearly 30% higher cut-off threshold of NT-pro-BNP and cTnT had to be applied in anuric PD patients.

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