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Clinical Studies of Interventions to Mitigate Cardiovascular Risk in Peritoneal Dialysis Patients
Dev Jegatheesan1, Yeoungjee Cho2, David W Johnson2
1Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
Insights
Cardiovascular disease (CVD) is a major concern for peritoneal dialysis (PD) patients, significantly increasing mortality risk. Addressing traditional, kidney-related, and PD-specific factors is crucial for mitigating CVD in this population.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Cardiovascular disease (CVD) affects up to 60% of patients undergoing peritoneal dialysis (PD).
- CVD is the leading cause of death in PD patients, with mortality rates 10-20 times higher than the general population.
- Risk factors for CVD in PD patients are multifactorial, including traditional, kidney disease-related, and PD-specific elements.
Purpose of the Study:
- To review evidence on cardiovascular interventions targeting modifiable risk factors in PD patients.
- To highlight key recommendations from the International Society for Peritoneal Dialysis (ISPD) Cardiovascular and Metabolic Guidelines.
- To inform clinical practice and improve cardiovascular outcomes in the PD population.
Main Methods:
- Literature review of studies on CVD risk factors and interventions in PD patients.
- Analysis of traditional risk factors (hypertension, dyslipidemia, obesity, etc.).
- Evaluation of nontraditional (anemia, inflammation, etc.) and PD-specific (dialysis solutions, etc.) risk factors.
Main Results:
- PD patients face elevated risks from a combination of traditional, kidney disease-related, and PD-specific factors.
- While interventions targeting these factors show promise, high-level clinical evidence is often limited.
- ISPD guidelines offer recommendations for managing cardiovascular risk in PD.
Conclusions:
- Comprehensive management of diverse risk factors is essential for reducing CVD in PD patients.
- Further research is needed to establish high-level evidence for cardiovascular interventions in this population.
- Adherence to ISPD guidelines can help optimize cardiovascular care for PD patients.
Abstract:
Cardiovascular disease (CVD) is highly prevalent in the peritoneal dialysis (PD) population, affecting up to 60% of cohorts. CVD is the primary cause of death in up to 40% of PD patients in Australia, New Zealand, and the United States. Cardiovascular mortality rates are reported to be approximately 14 per 100 patient-years, which are 10- to 20-fold greater than those of age- and sex-matched controls. The excess risk of CVD is related to a combination of traditional risk factors (such as hypertension, dyslipidemia, obesity, smoking, sedentary lifestyle, and insulin resistance), nontraditional (kidney disease-related) risk factors (such as anemia, chronic volume overload, inflammation, malnutrition, hyperuricemia, and mineral and bone disorder), and PD-specific risk factors (such as dialysis solutions, glycation end products, hypokalemia, residual kidney function, and ultrafiltration failure). Interventions targeting these factors may mitigate cardiovascular risk, although high-level clinical evidence is lacking. This review summarizes the evidence relating to cardiovascular interventions targeting modifiable CVD risk factors in PD patients, as well as highlighting the key recommendations of the International Society for Peritoneal Dialysis Cardiovascular and Metabolic Guidelines.
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