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Pre-existing cardiovascular disease and hyperlipidemia and mortality in peritoneal dialysis patients
Panpan Cao1, Xiaojiang Zhan2, Yueqiang Wen3
1Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Insights
Patients on continuous ambulatory peritoneal dialysis (CAPD) with pre-existing cardiovascular disease (CVD) and hyperlipidemia face a significantly higher risk of all-cause mortality. Managing dyslipidemia is crucial for improving long-term outcomes in this population.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- Cardiovascular disease (CVD) and dyslipidemia are common comorbidities in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- The combined impact of pre-existing CVD and dyslipidemia on mortality risk in CAPD patients requires further investigation.
Purpose of the Study:
- To evaluate the association between pre-existing cardiovascular disease (CVD) and dyslipidemia with all-cause mortality in patients on CAPD.
- To determine if the coexistence of CVD and dyslipidemia exacerbates mortality risk in the CAPD population.
Main Methods:
- A multicenter retrospective cohort study involving 2939 patients newly diagnosed with CAPD between 2005 and 2018.
- Patients were categorized based on pre-existing CVD and hyperlipidemia status.
- All-cause mortality was the primary outcome, with follow-up until June 30, 2019, using the missForest imputation method for missing data.
Main Results:
- Patients with pre-existing CVD alone had a 1.41-fold greater risk of all-cause mortality.
- Patients with both pre-existing CVD and hyperlipidemia had a 1.47-fold greater risk of all-cause mortality compared to controls.
- Hyperlipidemia alone did not significantly increase mortality risk (HR 0.98).
Conclusions:
- The coexistence of pre-existing cardiovascular disease and hyperlipidemia is significantly associated with increased all-cause mortality in CAPD patients.
- These findings underscore the importance of managing dyslipidemia in CAPD patients with cardiovascular conditions.
- Proactive management of comorbidities may improve long-term survival for patients on CAPD.
Objectives:
This study aimed to evaluate the impact of pre-existing cardiovascular disease (CVD) and dyslipidemia on mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
Methods:
This study was conducted as a multicenter retrospective cohort investigation. Eligible patients newly diagnosed with CAPD between January 1, 2005 and December 31, 2018 were enrolled in this study. Missing data were handled using the missForest imputation method. The primary outcome was all-cause mortality. All patients were followed until the cessation of peritoneal dialysis, death, completion of the 8-year follow-up period, or June 30, 2019, whichever occurred first.
Results:
Among the 2939 patients, 2132 (72.5%) had no pre-existing CVD or hyperlipidemia, 397 (13.5%) had hyperlipidemia alone, 274 (9.3%) had pre-existing CVD alone, and 136 (4.6%) had pre-existing CVD and hyperlipidemia. The median observational period was 33.6 (IQR 15.6-60.8) months. The number of deaths from all causes were 72 (36.8%), 67 (16.9%), 96 (35.0%), and 306 (14.4%) in the pre-existing CVD plus hyperlipidemia, hyperlipidemia alone, pre-existing CVD alone, and control groups, respectively. After adjusting for confounding factors, patients with pre-existing CVD alone, hyperlipidemia alone, and patients with both conditions had 1.41 (95% CI 1.03 to 1.94), 0.98 (95% CI 0.75 to 1.28) and 1.47 (95% CI 1.16-1.88)-fold greater risk of all-cause mortality, respectively, than patients without pre-existing CVD and hyperlipidemia. Notably, among patients with pre-existing CVD, hyperlipidemic patients had a higher risk of mortality than patients without hyperlipidemia (hazard ratio 0.89, 95% CI 0.61 to 1.31). Among patients without pre-existing CVD, hyperlipidemic patients had a higher risk of mortality than patients without hyperlipidemia (HR 1.10, 95% CI 0.83 to 1.48). There was no interaction effect between the coexistence of pre-existing CVD and hyperlipidemia, pre-existing CVD alone, and hyperlipidemia alone on all-cause mortality (β = 0.221, P = 0.976).
Conclusion:
In patients undergoing CAPD, the coexistence of pre-existing cardiovascular disease and hyperlipidemia is associated with a significantly higher risk of all-cause mortality. This finding suggests that the comorbidity may contribute to worse long-term outcomes and highlights the importance of dyslipidemia management in clinical practice.
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