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Cardiovascular disease in peritoneal dialysis patients
R G Fassett1, R Driver, H Healy
1Renal Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. r.fassett@uq.edu.au
Panminerva Medica
|October 28, 2009
Summary
Patients undergoing peritoneal dialysis face high cardiovascular risks due to atherosclerosis, influenced by traditional and non-traditional factors. Further research is needed to clarify long-term cardiovascular outcomes comparing dialysis types.
Area of Science:
- Nephrology
- Cardiology
- Vascular Biology
Background:
- Peritoneal dialysis patients exhibit high cardiovascular morbidity and mortality, linked to atherosclerotic cardiovascular disease.
- Risk factors include traditional (hypertension, diabetes) and non-traditional (oxidative stress, inflammation) elements.
- Endothelial dysfunction and arterial stiffness precede atherosclerosis, with measures like pulse wave velocity predicting outcomes.
Purpose of the Study:
- To investigate the association between oxidative stress, inflammation, and vascular/myocardial structure and function in peritoneal dialysis patients.
- To compare cardiovascular outcomes and risks between peritoneal dialysis and hemodialysis.
- To evaluate the long-term cardiovascular impact of different renal replacement therapies.
Main Methods:
- Review of existing randomized controlled trials and observational studies.
- Analysis of registry data comparing mortality rates between peritoneal dialysis and hemodialysis.
- Assessment of oxidative stress, inflammation, and arterial stiffness markers.
Main Results:
- Peritoneal dialysis is linked to lower oxidative stress and inflammation compared to hemodialysis.
- Conflicting results exist regarding the long-term cardiovascular advantage of peritoneal dialysis versus hemodialysis.
- Some data suggest lower initial mortality with peritoneal dialysis, but higher long-term mortality, while other data contradict this.
Conclusions:
- The choice between peritoneal dialysis and hemodialysis involves complex cardiovascular considerations.
- Evidence on the differential long-term cardiovascular effects of these therapies remains conflicting.
- Further long-term studies are essential to definitively assess cardiovascular outcomes in peritoneal dialysis patients.
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