Cardiovascular risk in peritoneal dialysis.

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Chronic kidney disease (CKD) patients exhibit numerous cardiovascular disease (CVD) and coronary artery disease (CAD) risk factors.
• Some risks, like age and gender, are immutable, while others, such as diabetes and hypertension, contribute to both CKD and CVD.
• Renal failure uniquely exacerbates or introduces factors like mineral metabolism disturbances and oxidative stress.

Purpose of the Study:

• To review the complex relationship between CKD, its treatments, and cardiovascular risk.
• To highlight the specific CVD risks associated with peritoneal dialysis (PD).
• To emphasize the importance of managing treatable risk factors across the continuum of kidney disease care.

Main Methods:

• Literature review and synthesis of existing research on CKD, CVD, and dialysis.
• Analysis of risk factors specific to CKD patients, including those related to PD.
• Discussion of therapeutic strategies for mitigating CVD risk in CKD.

Main Results:

• Peritoneal dialysis (PD) is associated with an atherogenic lipid profile, increased advanced glycation end product (AGE) formation, and hyperinsulinemia, all contributing to CVD risk.
• Despite these risks, PD offers benefits like excellent blood pressure control, achievable anemia management, and continuous ultrafiltration for volume management, which can reduce CVD risk.
• CKD patients possess multiple, often overlapping, CVD risk factors, necessitating comprehensive management.

Conclusions:

• Aggressive management of all modifiable risk factors is essential for CKD patients.
• Treatment should commence early in CKD progression and continue through dialysis and after kidney transplantation.
• A multi-faceted approach is required to mitigate the high CVD burden in patients with kidney disease.