Cardiovascular complications in peritoneal dialysis patients

Patients on peritoneal dialysis (PD) have a high risk of dying from cardiovascular disease (CVD), including myocardial infarction, arrhythmias, valvular disease, and sudden death. The risk of dying on PD, in contrast to HD, is rather low initially but steadily increases over time. Risk factors for CVD on PD need to be closely examined and research on possible interventions designed. PD patients typically gain weight, often to excess. They develop hyperlipidemia, particularly low-density lipoprotein and triglyceride levels, in part from the glucose load. PD patients are often hypertensive and sometimes volume overloaded. These are all traditional risk factors for CVD. However, in addition, there are some poorly examined risk factors for PD patients, including hypokalemia, shown to be associated with an increased risk of both peritonitis and death. PD patients may be inflamed related to non-physiologic PD fluid and peritonitis. PD patients over time often become profoundly 25(OH) vitamin D deficient, due to dietary constraints, lack of sun exposure and effluent losses. Such insufficiency of 25(OH)vitamin D deficiency seems to be a risk factor for CVD. Many of the above-described risk factors are either treatable or preventable. Very few randomized trials targeting treatment of cardiovascular risk factors have been done in PD patients. Whether a multiple pronged approach to CVD risk in PD patients would lower the later mortality remains to be tested.