Controlling inflammation in peritoneal dialysis: the role of pd-related factors as potential intervention targets

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Cardiovascular (CV) disease is the primary cause of mortality in patients undergoing peritoneal dialysis (PD).
• The precise mechanisms driving elevated CV risk in PD patients are not fully understood, hindering the development of targeted therapies.
• Patients with chronic kidney disease (CKD) share traditional CV risk factors, which are compounded by CKD-specific factors as renal function declines.

Purpose of the Study:

• To review the impact of novel risk factors associated with peritoneal dialysis (PD) initiation on cardiovascular (CV) mortality.
• To propose potential therapeutic strategies for mitigating CV risk in PD patients.

Main Methods:

• Literature review focusing on the transition from chronic kidney disease (CKD) to end-stage renal disease requiring PD.
• Analysis of traditional and CKD-related CV risk factors.
• Examination of novel risk factors introduced by PD, including dialysate composition and infection.

Main Results:

• CKD progression introduces risk factors like mineral metabolism disturbances, anemia, fluid overload, uremic toxicity, oxidative stress, and inflammation.
• Peritoneal dialysis initiation introduces additional risks such as chronic infections and factors related to PD fluids, notably glucose reabsorption.
• Existing therapeutic strategies may not fully address the unique CV risk profile of PD patients.

Conclusions:

• Understanding the specific mechanisms of CV risk in PD patients is crucial for effective treatment.
• Novel therapeutic strategies targeting PD-specific factors are needed to reduce cardiovascular mortality.
• Further research is required to validate proposed therapeutic interventions for PD-associated CV risk.