Peritoneal dialysis and cardiovascular disease.

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Cardiovascular (CV) death is the most frequent cause of mortality in peritoneal dialysis (PD) patients.
• Risk factors for CV death in PD patients encompass general population risks, end-stage renal disease (ESRD)-specific factors, and PD modality-specific issues.

Purpose of the Study:

• To identify and delineate the spectrum of cardiovascular risk factors in patients undergoing peritoneal dialysis.
• To differentiate between general, ESRD-related, and PD-specific contributors to cardiovascular mortality.

Main Methods:

• Review and synthesis of existing literature on cardiovascular risk factors in PD patients.
• Analysis of the contribution of various factors including hypertension, obesity, inflammation, malnutrition, calcifications, endothelial dysfunction, oxidative stress, glucose load, and overhydration.

Main Results:

• Hypertension is a major general risk factor in PD patients; obesity's role is debated.
• ESRD-specific factors like inflammation, malnutrition, calcifications, endothelial dysfunction, and oxidative stress contribute significantly to CV mortality.
• PD-specific factors include glucose load (leading to insulin resistance and atherogenic lipid profile) and overhydration (due to loss of residual renal function and ultrafiltration failure), with overhydration being the most critical.

Conclusions:

• Cardiovascular disease in PD patients is multifactorial, influenced by general, ESRD-related, and PD-specific risk factors.
• Overhydration emerges as the most significant PD-related risk factor for cardiovascular mortality.
• Management strategies should address these diverse risk factors to improve outcomes in PD patients.