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Comparison of cardiovascular mortality in hemodialysis versus peritoneal dialysis

Cheng Han Ng1, Zhi Hao Ong1, Hersharan Kaur Sran2,3

  • 1Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore. e0360747@u.nus.edu.

International Urology and Nephrology
|October 28, 2020
PubMed

Insights

Cardiovascular disease is common in dialysis patients. Hemodialysis patients experienced more atrial fibrillation, congestive heart failure, and peripheral arterial disease, but had lower cardiovascular mortality compared to peritoneal dialysis patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Epidemiology

Background:

  • Cardiovascular disease (CVD) is a leading cause of death in patients undergoing dialysis.
  • The increasing number of patients requiring renal replacement therapy necessitates a clear understanding of CVD epidemiology in both hemodialysis (HD) and peritoneal dialysis (PD) populations.

Purpose of the Study:

  • To systematically review and identify the epidemiology of cardiovascular disease in patients on hemodialysis versus peritoneal dialysis.
  • To compare the prevalence of specific cardiovascular events and mortality between HD and PD modalities.

Main Methods:

  • A meta-analysis adhering to MOOSE and PRISMA guidelines was performed.
  • Searches of Medline and Embase databases were conducted up to March 17, 2020.
  • Meta-analysis of proportions and pairwise comparisons were used to summarize prevalence and compare outcomes between dialysis modalities; meta-regression identified influencing factors.

Main Results:

  • Twenty-eight studies were included, summarizing CVD events like coronary artery disease, congestive heart failure, peripheral arterial disease, atrial fibrillation, and cardiovascular mortality.
  • Hemodialysis patients showed higher prevalence of atrial fibrillation (RR 1.287), congestive heart failure (RR 1.229), and peripheral arterial disease (RR 1.132).
  • Conversely, cardiovascular mortality was lower in hemodialysis patients compared to peritoneal dialysis patients (RR 0.892).

Conclusions:

  • Patients on peritoneal dialysis experienced fewer cardiovascular events but higher cardiovascular mortality than those on hemodialysis.
  • Further research is needed to elucidate the causal relationship between dialysis modality and observed cardiovascular outcomes.
Abstract

Keywords:
Cardiovascular diseaseDialysisEnd-stage kidney diseaseMeta-analysisMortality

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