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Increased peritoneal permeability at peritoneal dialysis initiation is a potential cardiovascular risk in patients
Yoshifumi Hamasaki, Kent Doi, Mototsugu Tanaka
1Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan. noiri-tky@umin.ac.jp.
Insights
Peritoneal dialysis patients using biocompatible solutions face cardiovascular risks. Higher peritoneal permeability at the start of peritoneal dialysis, indicated by the peritoneal equilibration test (PET) category, independently predicts cardiovascular events.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in patients undergoing peritoneal dialysis (PD).
- Biocompatible PD solutions with neutral pH are hypothesized to reduce CVD risk compared to conventional low-pH solutions.
- Predictors of CVD risk at PD initiation with biocompatible solutions require elucidation.
Purpose of the Study:
- To investigate clinical factors at PD initiation associated with cardiovascular events in patients using biocompatible PD solutions.
- To determine if peritoneal transport status influences cardiovascular risk.
Main Methods:
- Retrospective cohort study of 102 PD patients using neutral pH biocompatible solutions.
- Assessment of clinical parameters at PD initiation and cardiovascular events over five years.
- Utilized peritoneal equilibration test (PET) to categorize peritoneal transport status (D/Pcre).
Main Results:
- Eighteen of 102 patients experienced a cardiovascular event.
- Significant differences observed in age, CVD history, hemoglobin, albumin, CRP, D/Pcre, PET category, and protein clearance between patients with and without CVD events.
- High average to high peritoneal transporters (based on PET category) showed significantly higher CVD event and mortality rates (Log rank p=0.0003 and 0.005).
- PET category was independently associated with cardiovascular events via Cox proportional hazards model.
Conclusions:
- Peritoneal permeability, quantified by PET category at PD initiation, is an independent CVD risk factor in patients on biocompatible PD solutions.
- Elevated peritoneal permeability may indicate underlying subclinical vascular dysfunction.
Background:
Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Biocompatible peritoneal dialysis solutions with neutral pH have been anticipated to reduce cardiovascular disease more than conventional peritoneal dialysis solutions with low pH, but it remains unclear which factors at peritoneal dialysis initiation increase cardiovascular risk in patients using biocompatible peritoneal dialysis solutions. This study was undertaken to investigate which clinical factors at peritoneal dialysis initiation, including peritoneal transport status, are associated with cardiovascular event in patients using biocompatible peritoneal dialysis solution.
Methods:
This retrospective cohort study of peritoneal dialysis patients using biocompatible solutions with neutral pH assessed relations of clinical parameters at peritoneal dialysis initiation to cardiovascular event during the subsequent five years.
Results:
Of 102 patients who started peritoneal dialysis, cardiovascular event occurred in 18. Age, history of cardiovascular disease before peritoneal dialysis initiation, hemoglobin, serum albumin, C-reactive protein, peritoneal permeability defined by the ratio of dialysate to plasma creatinine concentration at 4 hr (D/Pcre) in peritoneal equilibration test (PET), number of patients in each PET category defined by D/Pcre, and peritoneal protein clearance significantly differed between patients with and without cardiovascular event. For patients divided according to PET category using Kaplan-Meier method, the group of high average to high peritoneal transporters exhibited significantly high incidence of cardiovascular event and mortality compared with the groups of low and low-average peritoneal transporters (Log rank; p=0.0003 and 0.005, respectively). A Cox proportional hazards model showed independent association of PET category classification with cardiovascular event.
Conclusions:
Peritoneal permeability expressed as PET category at peritoneal dialysis initiation is an independent cardiovascular risk factor in peritoneal dialysis patients using biocompatible peritoneal dialysis solution with neutral pH. Greater peritoneal permeability at peritoneal dialysis initiation might reflect subclinical vascular disorders.
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