Cardiovascular morbidity and mortality risk factors in peritoneal dialysis patients

Cardiovascular (CVS) morbidity and mortality in the endstage renal disease (ESRD) patients on peritoneal dialysis therapy is 10-30 folds higher than in general population. The prevalence of well known traditional risk factors such as age, sex, race, arterial hypertension, hyperlipidaemia, diabetes, smoking, physical inactivity is higher in the uraemic patients. Besides these, there are specific, nontraditional risk factors for dialysis patients. Mild inflammation present in peritoneal dialysis (PD) patients which can be confirmed by specific inflammatory markers is the cause of CVS morbidity and mortality in these patients. Hypoalbuminaemia, hyperhomocysteinaemia and a higher level of leptin are important predictors of vascular complications as well as CVS events in the PD patients. Plasma norepinephrine, an indicator of sympathetic activity, is high in the ESRD patients and higher in the PD patients than in the patients on haemodialysis (HD). Therefore, norepinephrine may be a stronger risk factor in the PD patients. The same applies to asymmetric dimethylargine (ADMA), an endogenous inhibitor of nitric oxide synthase, which is an important risk factor of CVS morbidity and mortality 15 % higher in the PD than the HD patients. Hyperphosphataemia, secondary hyperparathyroidism and high calcium x phosphate product have been associated with the progression of the coronary artery calcification and valvular calcifications and predict all-cause CVS mortality in the PD patients. Residual renal function (RRF) declines with time on dialysis but is slower in the PD than the HD patients. RRF decline is associated with the rise of proinflammatory cytokines and the onset of hypervolaemia and hypertension which increase the risk of CVS diseases, mortality in general and CVS mortality. In conclusion, it is very important to establish all CVS risk factors in the PD patients to prevent CVS diseases and CVS mortality in this population.

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Mineral metabolism and cardiovascular morbidity and mortality risk: peritoneal dialysis patients compared with haemodialysis patients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfl257 ◽

2006 ◽

Vol 21 (9) ◽

pp. 2513-2520 ◽

Cited By ~ 68

Author(s):

Marlies Noordzij ◽

Johanna C. Korevaar ◽

Willem J. Bos ◽

Elisabeth W. Boeschoten ◽

Friedo W. Dekker ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Mortality Risk ◽

Mineral Metabolism ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Dialysis Patients ◽

Cardiovascular Morbidity And Mortality

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Baseline carotid intima media thickness is associated with cardiovascular morbidity and mortality in peritoneal dialysis patients

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.13629 ◽

2021 ◽

Author(s):

Ebru Asicioglu ◽

Arzu Velioglu ◽

Hakki Arikan ◽

Mehmet Koc ◽

Serhan Tuglular ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Dialysis Patients ◽

Media Thickness ◽

Cardiovascular Morbidity And Mortality

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Volume Overhydration is Related to Endothelial Dysfunction in Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080802800415 ◽

2008 ◽

Vol 28 (4) ◽

pp. 397-402 ◽

Cited By ~ 21

Author(s):

Li-Tao Cheng ◽

Yan-Li Gao ◽

Chao Qin ◽

Jun-Ping Tian ◽

Yue Gu ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Endothelial Dysfunction ◽

Endothelial Function ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Volume Status ◽

Dialysis Patients ◽

Cardiovascular Morbidity And Mortality ◽

Dialysis Vintage

Objective In dialysis patients, volume overhydration is common and is related to increased risk of cardiovascular morbidity and mortality. However, it remains unclear whether volume overload imposes those detrimental effects through endothelial dysfunction. Methods In this cross-sectional study, 81 stable patients on continuous ambulatory peritoneal dialysis in a single center were recruited. Volume status was evaluated by extracellular water, assessed by bioimpedance analysis, and normalized to individual height (nECW). Endothelial function was estimated by endothelial-dependent flow-mediated dilatation (FMD) of the brachial artery and expressed as percentage change relative to baseline diameter. Results There were 37 male and 44 female patients (mean age 61 ± 12 years, dialysis vintage 20 ± 23 months). FMD in female patients was significantly higher than that in male patients (9.17% ± 6.23% vs 6.31% ± 5.01%, p < 0.05). FMD was negatively correlated with weight ( r = -0.308, p < 0.01), body mass index ( r = -0.242, p < 0.05), systolic blood pressure ( r = -0.228, p < 0.05), ECW ( r = -0.404, p < 0.001), and nECW ( r = -0.418, p < 0.001). No correlation was found between FMD and other variables. In multiple stepwise regression analysis, calcium x phosphate product (² = 0.422, p < 0.001), nECW (² = -0.343, p < 0.01), and dialysis vintage (² = -0.237, p < 0.05) were independent determinants of FMD (adjusted R2 = 0.327 for this model). Conclusion There was independent correlation between index of volume status and FMD, and higher nECW was related to worse endothelial function. The results of this study may help us understand the underlying mechanism of volume overhydration leading to increased cardiovascular morbidity and mortality in dialysis patients.

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Clinical Epidemiology of Major Nontraditional Risk Factors in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080502503s21 ◽

2005 ◽

Vol 25 (3_suppl) ◽

pp. 84-87 ◽

Cited By ~ 23

Author(s):

Carmine Zoccali ◽

Giuseppe Enia ◽

Giovanni Tripepi ◽

Vincenzo Panuccio ◽

Francesca Mallamaci

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

General Population ◽

Clinical Epidemiology ◽

High Plasma ◽

Hemodialysis Patients ◽

Plasma Norepinephrine ◽

The Difference ◽

Stage Renal Disease ◽

Esrd Patients

♦ Background End-stage renal disease (ESRD) is a situation with a cardiovascular (CV) risk profile of almost unique severity. While traditional risk factors dominate the scene in the general population, in chronic kidney disease (CKD), nontraditional risk factors play an increasingly important role, being perhaps dominant in ESRD patients. ♦ Objective We review the role inflammation [C-reactive protein (CRP)], hyperhomocysteinemia, high plasma norepinephrine, and accumulation of the endogenous inhibitor of the nitric oxide synthase asymmetric dimethylarginine (ADMA) in the high all-cause and CV mortality of patients on continuous ambulatory peritoneal dialysis (CAPD). ♦ Results The association between CRP and clinical outcomes in patients on peritoneal dialysis (PD) was examined in six studies totaling 692 subjects. The largest of these studies in Caucasians indicates that the independent risk of CV events in patients in the top CRP quartile is about five times higher than in the bottom quartile. Seven prospective studies, including over 1000 hemodialysis and 176 CAPD patients, reported both positive and negative associations between homocysteine and mortality and/or CV events. Because homocysteine circulates bound to albumin, negative associations — rather than negating the vasculotoxicity of homocysteine — most likely reflect the very deleterious effects of malnutrition. Plasma norepinephrine is higher in CAPD than in hemodialysis patients, and multivariate analyses suggest the difference quantitatively entails a 16% higher risk of incident CV events. Likewise, ADMA is more elevated in CAPD patients and such an elevation corresponds to a 15% increase in risk. ♦ Conclusion Nontraditional risk factors are far more prevalent in ESRD patients than in the general population. ADMA and norepinephrine may play a greater role in CV risk in CAPD than in hemodialysis patients.

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Dialysis modalities as risk factors in the development of atherosclerosis

Medicinski pregled ◽

10.2298/mpns0302017d ◽

2003 ◽

Vol 56 (1-2) ◽

pp. 17-21 ◽

Cited By ~ 1

Author(s):

Tatjana Damjanovic ◽

Nada Dimkovic

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Peritoneal Dialysis ◽

Carotid Arteries ◽

Renal Diseases ◽

Control Group ◽

Atherosclerotic Cardiovascular Disease ◽

Dialysis Patients ◽

Cardiovascular Morbidity And Mortality ◽

The Mean

Introduction Atherosclerosis is a major risk factor for increased cardiovascular morbidity and mortality in dialysis patients. First clinical symptoms are usually associated with initial atherosclerotic changes of blood vessels. The aim of this study was ultrasound evaluation of intimae media thickness (IMT) of carotid arteries in dialysis patients and its correlation with certain risk factors. Patients and methods IMT was measured in 45 dialysis patients with no signs of cardiovascular diseases:15 continuous ambulatory peritoneal dialysis (CAPD) patients, 30 haemodialysis (HD) patients and in 20 healthy controls. IMT was correlated with certain risk factors for atherosclerosis (general parameters - age, gender, duration of dialysis cause of renal diseases, parameters of nutrition, parameters of calcium and phosphorus metabolism, lipid parameters, blood pressure and smoking). Results The mean carotid artery IMT was significantly higher in dialysis patients than in the control group (p<0.05). In addition, the mean IMT was statistically significantly higher in PD than in HD patients (p<0.05). In CAPD patients there was a significant correlation between IMT and total and LDL cholesterol. In the second group (HD patients) IMT was significantly correlated with diastolic blood pressure, BMI and smoking. Conclusion Although atherosclerotic cardiovascular disease may not manifest in dialysis patients, IMT of carotid arteries significantly increases. Major risk factors affecting IMT are lipid disturbances in patients on peritoneal dialysis and hypertension, obesity and smoking in HD patients.

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Causes and risk factors of technique failure in peritoneal dialysis patients: a single unit study

10.26226/morressier.59a56f96d462b8028d895c4b ◽

2017 ◽

Author(s):

Lilia Ben Lasfar

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Single Unit ◽

Dialysis Patients ◽

Causes And Risk Factors ◽

Technique Failure

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THE RISK FACTORS AND OUTCOME OF FUNGAL PERITONITIS IN CONTINUOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

Indian Journal of Medical Microbiology ◽

10.1016/s0255-0857(21)01757-6 ◽

2009 ◽

Vol 27 (1) ◽

pp. 59-61

Author(s):

E Indhumathi ◽

V Chandrasekaran ◽

D Jagadeswaran ◽

M Varadarajan ◽

G Abraham ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Dialysis Patients ◽

Fungal Peritonitis

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The Iron Biology Status of Peritoneal Dialysis Patients May be a Risk Factor for Development of Infectious Peritonitis

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00052 ◽

2019 ◽

Vol 39 (4) ◽

pp. 362-374 ◽

Cited By ~ 1

Author(s):

Marwh Aldriwesh ◽

Noura Al-Dayan ◽

Jonathan Barratt ◽

Primrose Freestone

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Peritoneal Dialysis ◽

Stress Hormones ◽

Infection Risk ◽

Mortality And Morbidity ◽

Peritoneal Dialysate ◽

Susceptibility To Infection ◽

Infection Risk Factors

Background Infectious peritonitis is a clinically important condition contributing to the significant mortality and morbidity rates observed in peritoneal dialysis (PD) patients. Although some of the socioeconomic risk factors for PD-associated peritonitis have been identified, it is still unclear why certain patients are more susceptible than others to infection. Methods We examined the molecular components of human peritoneal dialysate (HPD) in an attempt to identify factors that might increase patient susceptibility to infection. Characterization studies were performed on initial and follow-up dialysate samples collected from 9 renal failure patients on PD. Results Our in vitro data showed that peritonitis-causing bacteria grew differently in the patient dialysates. Proteomic analysis identified an association between transferrin presence and infection risk, as peritoneal transferrin was discovered to be iron-saturated, which was in marked contrast to transferrin in blood. Further, use of radioactive iron-labeled transferrin showed peritoneal transferrin could act as a direct iron source for the growth of peritonitis-causing bacteria. We also found catecholamine stress hormones noradrenaline and adrenaline were present in the dialysates and were apparently involved in enhancing the growth of the bacteria via transferrin iron provision. This suggests the iron biology status of the PD patient may be a risk factor for development of infectious peritonitis Conclusions Collectively, our study suggests transferrin and catecholamines within peritoneal dialysate may be indicators of the potential for bacterial growth in HPD and, as infection risk factors, represent possible future targets for therapeutic manipulation.

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