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Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis
Silvia Lai1, Alessio Molfino1, Gaspare Elios Russo2
1Department of Clinical Medicine, Hemodialysis Unit, Umberto I, Polyclinic of Rome, Sapienza University of Rome, Rome, Italy.
Insights
Hemodialysis (HD) patients show better blood pressure control than peritoneal dialysis (PD) patients, reducing cardiovascular risk. Adequate monitoring is crucial for PD patients to manage left ventricular hypertrophy (LVH) and cardiothoracic ratio (CTR).
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Dialysis patients face higher mortality, primarily due to cardiovascular disease.
- Hypertension and volume overload are key drivers of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients.
- Other contributing factors include hyperparathyroidism, vascular calcification, arterial stiffness, and inflammation.
Purpose of the Study:
- To compare blood pressure (BP) and metabolic parameters.
- To assess cardiovascular changes, including cardiothoracic ratio (CTR), aortic arch calcification (AAC), and LV mass index (LVMI).
- To evaluate these parameters between PD and HD patients.
Main Methods:
- Enrolled 45 patients (23 HD, 22 PD).
- Conducted BP measurements, echocardiography, and chest X-ray to determine LVMI, CTR, and AAC.
- Evaluated inflammatory markers, intact parathyroid hormone (iPTH), and arterial blood gas levels.
Main Results:
- LVMI was significantly higher in PD patients compared to HD patients (139 ± 19 vs. 104 ± 22; p = 0.04).
- In PD patients, significant correlations were found between iPTH, C-reactive protein, and LVH presence (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively).
- CTR was increased in PD patients versus HD patients; no significant differences in cardiac calcifications were observed.
Conclusions:
- HD patients demonstrated more effective BP control than PD patients.
- Adequate fluid and metabolic management are essential for BP control, correlating with LVMI and CTR increases in dialysis patients.
- While PD offers a better quality of life, it may pose a higher cardiovascular risk for patients if not meticulously monitored.
Introduction:
Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients.
Materials And Methods:
45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH) and arterial blood gas analysis were also evaluated.
Results:
LVMI was higher in PD than HD patients (139 ŷ 19 vs. 104 ŷ 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined.
Conclusions:
Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored.
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