[Peritoneal dialysis and cardiopulmonary comorbidity]

The number of patients suffering from end-stage renal disease (ESRD) throughout the world continues to increase. The unacceptably high mortality in this population has led to current efforts to optimize dialysis treatment and has focused attention on comorbidities and their interaction with dialysis treatment. Cardiovascular morbidity is the most important cause of death in patients with ESRD. The advantages of hemodynamic stability and volume regulation offered by peritoneal dialysis (PD), compared with hemodialysis (HD), have made PD preferable for patients with cardiovascular comorbidity. However, recent studies on PD have shown a higher mortality in patients with coronary artery disease or congestive heart failure than in similar patients receiving HD. Nevertheless, the validity of the studies is limited by their retrospective study design and, furthermore, at the time of data collection, new dialysis solutions were not available and the percentage of patients on automated PD was low. Little is known about the frequency of chronic obstructive pulmonary disease (COPD) in the ESRD population, but COPD data on the general population without kidney disease suggest that significant underestimation of both prevalence and mortality of this disease can be supposed in the ESRD population. Data currently available do not suggest that PD is contraindicated in patients with cardiac diseases. However, consequent diagnostic and therapeutic interventions of cardiac comorbidities and corresponding risk factors are required. Patients suffering from mild COPD should not be generally excluded from PD as renal replacement therapy, although individually tailored modifications of dialysate volume and frequency of exchanges are often required.