Cardiovascular risk factors in diabetic patients undergoing continuous ambulatory peritoneal dialysis

To determine the impact of continuous ambulatory peritoneal dialysis (CAPD) on cardiovascular risk factors in diabetic patients, we evaluated serum lipid profiles and plasma levels of coagulation and fibrinolysis parameters in 23 diabetic patients on long-term CAPD (aged 55 +/- 14 years, mean +/- SD), and compared them with those of diabetic patients undergoing hemodialysis (n = 62, 56 +/- 10 years) or kidney transplantation (n = 14, 43 +/- 14 years), and 40 normal subjects (39 +/- 10 years). All of the parameters were compared using analysis of covariance to adjust for the difference in age among the four groups in males and females separately. In the male CAPD patients, there were no significant differences in the serum concentrations of lipids, lipoproteins, and apolipoproteins. In contrast, in the female CAPD patients, the levels of triglyceride and apolipoprotein (apo) B and the low-density lipoprotein (LDL) cholesterol/ high-density lipoprotein (HDL) cholesterol ratio were significantly higher than those in the normal females. Lipoprotein (a) did not differ significantly among the four male and female groups. The plasma levels of fibrinogen and von Willebrand factor were higher both in the male and in the female CAPD patients than in the other corresponding groups. There was no significant difference in the levels of plasminogen activator inhibitor-1 among the four groups. In conclusion, CAPD is associated with a more atherogenic lipid profile than are hemodialysis and kidney transplantation in female diabetic patients, but not in male diabetic patients. Both male and female diabetic patients on CAPD have a hypercoagulability state but not a decreased fibrinolysis state.