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Cardiovascular risk in peritoneal dialysis
1Nephrology Division, Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada. sarah.prichard@muhc.mcgill.ca
Insights
Patients with chronic kidney disease (CKD) face elevated cardiovascular disease (CVD) risks due to modifiable and non-modifiable factors. Early management of treatable risks throughout CKD, dialysis, and post-transplant is crucial for reducing CVD incidence.
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.
Abstract:
All patients with CKD have multiple risk factors for CVD and CAD in particular. Some of these risk factors such as age and gender cannot be modified. Others such as diabetes and hypertension are not only CVD risk factors but are also the cause of the patient's CKD. Finally there are a group of risk factors such as disturbances of mineral metabolism and oxidative stress which are present either uniquely in or are exaggerated by renal failure. PD gives patients a more atherogenic lipid and lipoprotein profile, puts them at greater risk for AGE formation and usually causes hyperinsulinemia. All of these contribute to CVD risk. However, they can also achieve excellent blood pressure control, usually easily reach targets for anemia management and have continuous ultrafiltration allowing for the maintenance of good volume status, all of which will reduce risk for CVD. All treatable risk factors should be treated early in the development of CKD and should continue through their time on dialysis and after transplantation.
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