Cardiovascular disease in haemodialysis and peritoneal dialysis: arguments pro peritoneal dialysis

Biesen, Wim Van; Verbeke, Frederick; Vanholder, Raymond

doi:10.1093/ndt/gfl601

Cited by 30 publications

(14 citation statements)

References 65 publications

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“…The advantages of peritoneal UF include: continuous removal of extracellular fluid with better hemodynamic stability compared to intermittent hemofiltration, sodium sieving with maintenance of normonatremia, and the absence of an arteriovenous access that may exacerbate HF. It better preserves the residual renal function, improves clearance of medium-sized molecules, some of which may be myocardial depressants, and might even improve the systemic inflammatory state [7,8,9,10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure: Potential Prognostic Factors

et al. 2013

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Background: Peritoneal dialysis (PD) is increasingly used for long-term management of refractory congestive heart failure (CHF). In this study, we investigated the outcome of patients with refractory CHF treated with PD, aiming to identify potential prognostic factors for long term-survival. Methods: This was a prospective observational study over a period of 42 months which included 37 refractory CHF patients. Results: Median survival on PD was 14 months (1-41 months). Long survivors had serum sodium >132 mEq/l (p < 0.001), serum albumin >3.2 g/dl (p < 0.001) and hospitalization rate <2 days per month a year before starting the treatment (p = 0.008). Patients in the lowest survival quartile had lower serum albumin (2.8 vs. 3.5 g/dl in longer survivors, p = 0.003) and serum sodium (126 vs. 137 mEq/l, p < 0.0001), higher serum leukocyte count (7,500 vs. 6,800/μl in long survivors, p = 0.033), higher glomerular filtration rate (39.4 vs. 29.9 ml/min/1.73 m², p = 0.035), had more hospitalization before starting the treatment (3.4 vs. 1.9 days per month, p = 0.003) and lower estimated left ventricular mass index (113 vs. 137 g/m², p = 0.035). Long-term survivors demonstrated significant improvement in the New York Heart Association functional class by a median of one class, reduced hospitalization rate by 55% and decrease in dependence on intravenous diuretics and vasoactive medications (73% drop in CHF day care visits during the first year of treatment). Conclusions: Survival of patients with refractory CHF treated with PD is highly variable. Serum sodium, serum albumin and hospitalization rate are important prognostic factors for long-term survival. Long survivors demonstrated improved functional status, reduced hospitalization and mortality rates.

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Section: Introductionmentioning

confidence: 99%

Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure: Potential Prognostic Factors

et al. 2013

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“…In addition, vascular and myocardial dysfunction are also prominent, increasing the likelihood of cardiovascular disease morbidity and mortality in dialysis patients [4]. A number of studies have documented that peritoneal dialysis is associated with decreased levels of oxidative stress and inflammatory markers compared to haemodialysis [5]. A small number of trials have extended this work to determine associations between oxidative stress and inflammation with vascular or myocardial structure and function with equivocal results [4,6].…”

Section: Introductionmentioning

confidence: 99%

Comparison of markers of oxidative stress, inflammation and arterial stiffness between incident hemodialysis and peritoneal dialysis patients – an observational study

et al. 2009

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BackgroundPatients on peritoneal and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. The atherosclerosis is associated with increased arterial stiffness, endothelial dysfunction and elevated oxidative stress and inflammation. The aims of this study are to investigate the effects of peritoneal and hemodialysis on arterial stiffness, vascular function, myocardial structure and function, oxidative stress and inflammation in incident patients with end stage kidney disease.MethodsThis is an observational study. Eighty stage five CKD patients will be enrolled and followed for one-year. Primary outcome measures will be changes in 1) arterial stiffness measured by aortic pulse wave velocity, 2) oxidative stress assessed by plasma F2 isoprostanes and 3) inflammation measured by plasma pentraxin-3. Secondary outcomes will include additional measures of oxidative stress and inflammation, changes in vascular function assessed using the brachial artery reactivity technique, carotid artery intimal medial thickness, augmentation index and trans thoracic echocardiography to assess left ventricular geometry, and systolic and diastolic function. Patients will undergo these measures at baseline (6–8 weeks prior to starting dialysis therapy), then at six and 12 months after starting dialysis.DiscussionThe results of this study may guide the choice of dialysis modality in the first year of treatment. It may also lead to a larger study prospectively assessing the effect of dialysis modality on cardiovascular morbidity and mortality.Trial RegistrationACTRN12609000049279

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“…Schwabe et al demonstrated elevated levels of sCD40L in patients with chronic renal disease in comparison to healthy controls [28]. This and other studies raise the question whether dialysis modality may influence cardiovascular risk and mortality [29–31]. In the DOC study, after correction for possible confounders, no statistically significant difference was found in mortality between HD and PD patients [32].…”

Section: Discussionmentioning

confidence: 97%

“…But there exist potential differences between HD and PD in influencing cardiovascular risk factors, which are altered by uremic toxins [34], fluid overload, and inflammation [35]. Indeed, prior publications are heterogeneous in valuating possible advantages and disadvantages of the two dialysis modalities HD and PD [29–31]. …”

Section: Discussionmentioning

confidence: 99%

Elevation of Platelet and Monocyte Activity Markers of Atherosclerosis in Haemodialysis Patients Compared to Peritoneal Dialysis Patients

Stach

Karb

Akın

et al. 2017

Mediators of Inflammation

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Purpose The predominant cause of mortality in dialysis patients are cardiovascular events. Platelet and monocyte activity markers play an important role in cardiovascular mortality and were assessed and related to dialysis quality criteria in haemodialysis (HD) and peritoneal dialysis (PD) patients. Methods For this prospective comparative study, HD patients (n = 41) and PD patients (n = 10) were included. In whole blood samples, surface expression of CD62P and CD40L on platelets, tissue factor binding on monocytes, and platelet-monocyte aggregates were measured by flow cytometry. Plasma levels of MCP-1, IL-6, TNFα, and soluble CD40L were analysed by enzyme-linked immunosorbent assay. Results Haemodialysis patients showed a significantly higher CD62P expression on platelets (p = 0.017), significantly higher amount of platelet-monocyte aggregates (p < 0.0001), and significantly more tissue factor binding on monocytes (p < 0.0001) compared to PD patients. In PD patients, a significant correlation between Kt/V and platelet CD40L expression (r = 0.867; 0.001) and between Kt/V and platelet CD62P expression (r = 0.686; p = 0.028) was observed, while there was no significant correlation between Kt/V and tissue factor binding on monocytes and platelet-monocyte aggregates, respectively. Conclusion Platelet and monocyte activity markers are higher in HD patients in comparison with those in PD patients, possibly suggesting a higher risk of cardiovascular morbidity and mortality.

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Cardiovascular disease in haemodialysis and peritoneal dialysis: arguments pro peritoneal dialysis

Cited by 30 publications

References 65 publications

Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure: Potential Prognostic Factors

Peritoneal Dialysis in Patients with Refractory Congestive Heart Failure: Potential Prognostic Factors

Comparison of markers of oxidative stress, inflammation and arterial stiffness between incident hemodialysis and peritoneal dialysis patients – an observational study

Elevation of Platelet and Monocyte Activity Markers of Atherosclerosis in Haemodialysis Patients Compared to Peritoneal Dialysis Patients

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