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[Correlation between dialysis solution type and cardiovascular morbidity rate in patients undergoing continuous
Verica Stanković-Popović1, Doko Maksić, Zarko Vucinić
1Vojnomedicinska akademija, Funkcijska dijagnostika i kabinet za nefrologiju, Dijagnosticko poliklinicki centar, Beograd, Srbija. drendo@beotel.yu
Insights
Peritoneal dialysis (PD) significantly impacts cardiovascular health, particularly left ventricular function and atherosclerosis. Patient age, not dialysis duration or solution biocompatibility, is the primary driver of accelerated atherosclerosis in PD patients.
Area of Science:
- Nephrology
- Cardiology
- Biomaterials Science
Context:
- Peritoneal dialysis (PD) is a crucial renal replacement therapy.
- PD patients exhibit a higher risk of cardiovascular diseases.
- Dialysis solution biocompatibility may influence patient outcomes.
Purpose:
- To assess cardiovascular changes in chronic PD patients.
- To compare cardiovascular effects based on dialysis solution biocompatibility.
- To identify factors influencing cardiovascular morbidity in PD.
Summary:
- A longitudinal study compared cardiovascular parameters in PD patients using bioincompatible (PDP-1) versus biocompatible (PDP-2) solutions, alongside a control group.
- Evaluations included echocardiography (ejection fraction, left ventricular hypertrophy, valvular calcification) and carotid artery ultrasonography (IMT, lumen narrowing, plaque).
- While PD significantly affected left ventricular function and peripheral atherosclerosis, patient age emerged as a more critical factor than dialysis duration or solution type.
Impact:
- Highlights the significant cardiovascular burden associated with peritoneal dialysis.
- Suggests that patient age is a more potent accelerator of atherosclerosis than dialysis characteristics.
- Informs clinical practice regarding cardiovascular risk management in PD patients.
Background/Aim:
Peritoneal dialysis (PD) patients have an increased risk for cardiovascular diseases. The aim of the study was to evaluate the cardiovascular changes in patients undergoing chronic PD and the eventual existing differences depending on biocompatibility of dialysis solutions.
Methods:
After 3 +/- 2 years of starting PD, 21 PD patients on the treatment with bioincompatible dialysis solutions (conventional glucose- based solutions: PDP-1), average age 47.43 +/- 12.87 years, and 21 PD patients on the treatment with biocompatible dialysis solutions (neutral solutions with lower level of glucose degradation products, lower concentration of Ca2+ and neutral pH: PDP-2), average age 68.62 +/- 13.98 years, participated in the longitudinal study. The average number of episodes of peritonitis was similar in both groups: 1 episode per 36 months of the treatment. The control group included 21 patients with preterminal phase of chronic renal failure (Glomerular Filtration Rate: 22.19 +/- 10.73 ml/min), average age 65.29 +/- 13.74 years. All the patients underwent transthoracal echocardiography (in order to detect: eject fraction (EF), left ventricular hypertrophy (LVH), and valvular calcification (VC) and B-mode ultrasonography of common carotid artery (CCA): IMT, lumen narrowing, and plaque detection.
Results:
The values of EF were: in PDP-1 group 62.05 +/- 5.65%, in PDP-2 group 53.43 +/- 7.47%, and in the control group 56.71 +/- 8.12% (Bonferroni test, p = 0.001). The recorded LVH was: in PDP-1 group in 47.6% of the patients; in PDP-2 group in 61.9% of the patients; and in control the group in 52.4% (chi2 test; p = 0.639). The detected VC was: in PDP-1 in 52.4% of the patients, in PDP-2 group in 42.9% of the patients, and in the control group in 23.8% of the patients (chi2 test; p = 0.776). The IMT was: in PDP-1 group 1.26 +/- 0.54 mm, in PDP-2 group 1.23 +/- 0.32, and in the control group 1.25 +/- 0.27 mm (Bonferroni test; p = 0.981). An average lumen narrowing was: in PDP-1 group 13.78 +/- 18.26%, in PDP-2 group 18.57 +/- 22.98%, and in the control group 25.00 +/- 28.02% (Kruskal Wallis test; p = 0.413). Calcified plaques of CCA were detected in PDP-1 group in 61.9% of the patients, in PDP-2 group in 85.7%, of the patients and p = 0.159).
Conclusion:
Generally, PD had a significant influence on cardiovascular morbidity in the treated patients, especially on the left ventricular function and peripheral atherosclerosis. The age of the patients had more influence on acceleration of atherosclerosis than the length of dialysis or biocompatibility of dialysis solutions.
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