[Dialysis modality and cardiac disease in chronic kidney insufficiency]

Area of Science:

• Nephrology and Cardiology
• Renal Replacement Therapy

Context:

• End-stage renal disease (ESRD) patients often have comorbid cardiac disease, complicating treatment decisions.
• Cardiovascular disease (CVD) progression is a major concern in ESRD, influenced by dialysis modality.
• Arterial hypertension, dyslipidemia, and thrombosis are key CVD risk factors exacerbated by chronic kidney disease (CKD).

Purpose:

• To evaluate the comparative usefulness of peritoneal dialysis (PD) and intermittent hemodialysis (HD) in ESRD patients with cardiac disease.
• To analyze modality-specific factors influencing cardiovascular health and patient outcomes.

Summary:

• Peritoneal dialysis (PD) presents challenges in managing arterial hypertension and fluid overload, particularly after loss of residual renal function, compared to hemodialysis (HD).
• PD patients exhibit a more atherogenic lipid profile and higher thrombosis risk. However, PD preserves residual renal function longer and avoids arteriovenous fistula creation.
• While HD may offer better cardiovascular risk management, PD can improve quality of life and reduce hospitalizations in selected cardiac failure patients with mild renal insufficiency.

Impact:

• Understanding these differences is crucial for optimizing dialysis modality selection in ESRD patients with cardiac comorbidities.
• This analysis aids clinicians in balancing the benefits and risks of PD versus HD to improve patient outcomes and quality of life.
• The findings highlight the need for tailored management strategies addressing specific cardiovascular risks associated with each dialysis modality.