Abstract
Spironolactone in Continuous Ambulatory Peritoneal Dialysis Patients Improves Cardiac Function
Background: Cardiovascular disease is recognized as the predominant cause of death in patients with chronic kidney disease. Use of spironolactone in conjunction with an angiotensin converting-enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) reduce the risk of cardiac mortality and morbidity in patients with normal or slightly decreased renal function. But because dialysis patients are prone to hyperkalemia, a known side effect of spironolactone, this treatment has not been used in that population. We assessed whether low-dose spironolactone (3×25 mg weekly) could be administered in continuous ambulatory peritoneal dialysis (CAPD) patients with moderate-to-severe heart failure to improve cardiovascular function without inducing hyperkalemia.
Methods: Our triple-blind randomized placebo-controlled study enrolled 18 patients who were under peritoneal dialysis treatment with moderate-to-severe heart failure and left ventricular ejection fraction of not more than 45%, ACEI use, and a serum potassium level less than 5.5 mEq/L. One group of 9 patients received 3×25 mg of spironolactone weekly, and another group received placebo for 6 months. Echocardiography to assess ejection fraction was also performed for both groups at the beginning and the end of the study. Serum potassium was measured every 4 weeks.
Results: The mean ejection fraction increased more in the spironolactone group (p = 0.002) than in placebo group (p = 0.4) during the study. There was no significant change in serum potassium between the two groups (p > 0.05), but there was a significant difference in mortality between the groups (p = 0.03).
Conclusions: Administration of spironolactone in CAPD patients with severe heart failure substantially improved cardiac function and decreased mortality without development of severe hyperkalemia.
Clinical and Laboratory Features of Vascular Calcification in Peritoneal Dialysis Patients
Objectives: Patients with chronic kidney disease (CKD) are at increased risk of cardiovascular morbidity and mortality. Almost half of chronic dialysis patients eventually die of cardiovascular disease. This dialysis population is exposed to both traditional and nontraditional risk factors of cardiovascular disease. In recent years, vascular calcification (VC) has emerged as an important factor in predicting long-term outcome. The purpose of the present study was to find factors determining VC in peritoneal dialysis (PD) patients.
Methods: Our cross-sectional study investigated the prevalence of VC in our PD patients. A chest radiograph was taken for each enrolled patient. The presence of VC was interpreted and graded according to its gravity. Demographic data, biochemical data, and residual kidney function (RKF), dialysis dosage [weekly creatinine clearance (wCCr), Kt/V], and levels of inflammatory cytokines [interleukins 6, 10, and 18 (IL-6,-10,-18) and fetuin-A] were determined.
Results: Among 152 stable PD patients, VC over the aortic arch was found in 57 patients (37.5%), and 13 patients were categorized grade 1 (8.5%); 29, grade 2 (19.1%); and 15, grade 3 (9.9%). Comparison analysis revealed that the VC was more dominant as age, PD duration, and body mass index (BMI) increased (all p < 0.05). Concurrent diabetes and hypertension did not contribute to VC. The RKF, wCCr, and Kt/V decreased gradually as VC was graded higher. There was no difference in VC prevalence between PD modalities (continuous ambulatory PD: 38.5%; automated PD: 31.9%; p > 0.05). A significantly lower albumin level was also observed (grade 3 compared with a non-VC group: 3.5 ± 0.4 g/dL vs. 3.8 ± 0.4 g/dL, p < 0.05), and there was a trend to a progressive increase in IL-6, IL-10, and tumor necrosis factor-α. No significant change in serum fetuin A was observed. Multivariate regression analysis revealed that age, PD therapy duration, BMI, and RKF were independent predictors of VC.
Conclusions: In PD patients, VC is prevalent, and this vasculopathy is associated with malnutrition–inflammation syndrome. The presence of RKF was an important determinant of VC in PD patients.
Comparison of Oxidative Stress, Endothelial Dysfunction, and Arterial Stiffness between Continuous Ambulatory Peritoneal Dialysis and Hemodialysis
Aim: Vascular endothelium releases number of biologically active mediators, including NO, which regulates vessel tone. Endothelial (endo) dysfunction is a risk factor for cardiovascular disease in dialysis patients (pts). Our study comparatively assessed endo dysfunction in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) pts.
Methods: Our prospective cross-sectional study considered only pts with no signs of inflammation—that is, they were C-reactive protein–negative. Oxidative stress markers were determined by evaluating serum malondialdehyde (as a thiobarbituric acid reactive substance) and protein carbonyl content. Protein sulfhydryl content reflects antioxidant activity in serum. To assess endo function, an augmentation index calculated from derived aortic wave forms using radial pulse wave analysis was measured. As a marker of arterial stiffness, pulse wave velocity was measured. Serum NO was measured as a marker of endo function. All pts underwent a cardiac evaluation for evidence of coronary artery disease.
Results
HD = hemodialysis; CAPD = continuous ambulatory peritoneal dialysis; NS = nonsignificant; LVH = left ventricular hypertrophy; ECG = echocardiogram; AIx = augmentation index.
Conclusions: Markers of oxidative stress, endo dysfunction and arterial stiffness were significantly higher in dialysis pts than in healthy volunteers. The same parameters were higher in HD pts than in CAPD pts because of low serum albumin. There was a significant association of markers of oxidative stress, endo dysfunction, and arterial stiffness with cardiovascular disease in dialysis pts.
Peritoneal Function besides Aortic Stiffness and Nutrition Status Predicts the Risk for Cerebrovascular Disease in Peritoneal Dialysis Patients
Background: Cerebrovascular disease (CeVD) is a major determinant of the prognosis of dialysis patients (pts). Our study examined the severity of CeVD in pts on continuous ambulatory peritoneal dialysis (CAPD) and identified risk factors contributory to the development of CeVD in PD pts.
Methods: Consecutive outpatients of our department were recruited to the study. Pts with symptoms of stroke, transient ischemic attack, or dementia, or with a past history of CeVD were excluded. We analyzed 38 CAPD pts (mean age: 62.7 years; mean duration of PD: 12.6 months) and 44 pre-dialysis pts as controls (mean age: 64.6 years). CeVD was diagnosed using magnetic resonance (MR) imaging of brain and MR angiography of the carotid/intracranial artery. The severity of lacunar infarction (LI) was evaluated by LI number (LIN). The severity of carotid/intracranial artery stenosis was evaluated as a percentage (%Stns). Brachial-ankle pulse wave velocity (baPWV) and routine laboratory parameters were also measured.
Results: There were no significant differences in age, sex, or prevalence of diabetes between PD pts and controls. There were also no differences in the severity of CeVD (LIN: 10.0 ± 8.5 PD vs. 10.0 ± 8.8 control; prevalence of %Stns > 50%: 27.3% PD vs. 26.3% control). In the PD group, LIN correlated significantly with dialysate-to-plasma ratio (D/P) of creatinine (Cr) (r = 0.402), age (r = 0.535), baPWV (r = 0.353), serum urea nitrogen (UN—r = –0.398), albumin (r = –0.375), and serum P (r = –0.328). In the PD group, pts with severe infarction (LIN > 10) were significantly older, had higher levels of D/P Cr, serum Ca, and baPWV, and lower levels of serum Cr, UN, and P than did those with mild infarction (LIN > 50%), who presented with a higher prevalence of diabetes and had higher levels of baPWV, serum Ca, and lower levels of albumin than did those with mild stenosis (%Stns < 50%). Multivariate analysis revealed that LIN was independently associated (p < 0.15) with age and D/P Cr, and that the prevalence of severe stenosis was independently associated with levels of D/P Cr, baPWV, hematocrit, and prevalence of diabetes. However, neither LIN nor %Stns was significantly associated with smoking habits, blood pressure, or serum lipids.
Conclusions: CeVD already developed before the initiation of dialysis, and PD may block the additional progression of CeVD. In PD pts, D/P Cr, baPWV, and nutrition status constitute novel risk factors for CeVD.
The Role of Angiotensin Receptor Blockade for Cardiorenovascular Protection in Maintenance Peritoneal Dialysis Patients
Background/Aim: Activation of the renin–angiotensin–aldosterone system (RAAS) is pivotal in the pathophysiology of cardiovascular (CV) and renal disease. In patients with kidney failure, including patients on renal replacement therapy, CV disease is the leading cause of mortality. Although angiotensin II receptor blockers (ARBs) reduce CV disease events in patients with diabetes and chronic kidney disease, their effect in patients with kidney failure on peritoneal dialysis (PD) therapy is not well known.
Methods: We retrospectively studied 244 maintenance PD patients (87 men, 157 women; age: 14 – 80 years) who started PD during 1996 – 2006 and who had a PD duration of at least 2 years. Patients were divided into two groups based on ARB prescription, and many variables associated with long-term morbidity and clinical outcomes, including CV events (ischemic heart disease, stroke, and congestive heart failure) and residual renal function, were analyzed.
Results: No obvious differences were observed between the two groups in general data, including age, sex, hemodynamic status, duration of therapy, and laboratory data for clinical practice. However, the group prescribed ARB showed better preservation of clearance (monthly ΔKt/V, p = 0.04), resulting in a significant reduction in relative risk for CV events, delayed CV events (duration to events, p = 0.048) as compared with chronic PD patients without ARB treatment.
Conclusions: The exaggerated effects are debatable because of the small sample size. However, prescription of an ARB may be effective in preserving residual renal function and reducing and delaying CV events in patients undergoing long-term PD therapy.
The Effect of Low-Calcium Dialysate on Calcium Phosphate Metabolism, Left Ventricular Function in Continuous Ambulatory Peritoneal Dialysis Patients
Objectives: To investigate the effect of low-calcium dialysate on calcium phosphate metabolism and left ventricular function in continuous ambulatory peritoneal dialysis (CAPD) patients with higher serum calcium, and to explore optimal treatment for these patients.
Methods: The study enrolled 33 CAPD patients with serum calcium above 2.12 mmol/L and intact parathyroid hormone (iPTH) under 150 pg/mL. Standard-calcium dialysis solution (1.75 mmol/L) was changed to lower-calcium solution (1.25 mmol/L) in this study. Oral calcium carbonate (3 g/d) was prescribed. Serum calcium, phosphate, albumin, alkaline phosphatase, sodium, potassium, creatinine, blood urea nitrogen (BUN), hemachrome, and iPTH were periodically measured (week 0, 4, and 8). Left ventricular function was examined by echocardiography at the beginning and the end of the study.
Results: Serum calcium decreased and iPTH increased significantly after patients used lower-calcium solution for 4 weeks. The improvements in E/Amax and isovolumic relaxation time (IVRT) were statistically significant after 8 weeks2 treatment. We observed an inverse relationship between changes in serum calcium (weeks 8 and 12) and E/Amax (r = –0.39, p < 0.05), but a positive correlation between serum calcium concentration and IVRT (r = 0.49, p < 0.05).
Conclusions: Treatment with low-calcium dialysate improved left ventricular function in CAPD patients with a high level of serum calcium. The efficacy of this treatment may be associated with an amelioration of calcium–phosphate metabolism and calcium overload.
The Effect of Low-Calcium Dialysate on Calcium–Phosphorus Metabolism and Arterial Compliance of Continuous Ambulatory Peritoneal Dialysis Patients with Immunoglobulin a Nephropathy
Objectives: To investigate the effect of low-calcium dialysate on calcium and phosphorus metabolism and arterial compliance (AC) in continuous ambulatory peritoneal dialysis (CAPD) patients with high or normal serum calcium, and to provide an optimal treatment for those patients.
Methods: Our study investigated 33 CAPD patients (standard-calcium dialysate, oral calcium carbonate 2.56 ± 0.51 g/d) with high or normal serum calcium [corrected serum calcium above 2.12 mmol/L, intact parathyroid hormone (iPTH) below 150 pg/mL]. Standard-calcium dialysis solution (1.75 mmol/L) was changed to lower-calcium solution (1.25 mmol/L). Oral calcium carbonate (3 g/d) was prescribed. Serum levels of calcium, phosphorus, albumin, alkaline phosphatase, sodium, potassium, creatinine, blood urea nitrogen, hemachrome, total cholesterol, triglycerides, low-density lipoprotein, and iPTH were measures periodically (weeks 0, 4, 8, and 12). Echocardiography was used to examine AC at the same time.
Results: Serum calcium, phosphorus, and Ca×P product decreased, and serum iPTH increased significantly in the treated patients, and maintained an acceptable level after 4 weeks’ treatment with lower-calcium dialysis solution. The AC improvement was statistically significant after 8 weeks’ treatment (p < 0.05). We observed negative correlations between changes in serum calcium (weeks 8 and 12), phosphorus (week 12) concentration, and AC (Ca: r = –0.39, p < 0.05; r = –0.38, p < 0.05; phosphorus r = –0.52, p < 0.05). The changes in Ca×P product (week 12) and AC showed an inverse relationship (r = –0.47, p < 0.05).
Conclusions: Effective changes occurred in serum calcium, phosphorus, and Ca×P product in CAPD patients with high or normal serum calcium after treatment with low-calcium dialysate and adequate calcium carbonate intake. As a result, AC improved in the patients.
The Association between Electrocardiographic Left Ventricular Hypertension and Heart Rate in Continuous Ambulatory Peritoneal Dialysis Patients
Objectives: Overall, the proportion of deaths from cardiovascular disease (CVD) reaches 40% – 50% in dialysis patients. Left ventricular hypertension (LVH) is an independent risk factor for increased CVD mortality. Resting clinic-casual heart rate (HR) is associated with all-cause and CVD mortality in the general population. Thus, we conducted a cross-sectional study in continuous ambulatory peritoneal dialysis (CAPD) patients to explore the association between LVH and HR.
Methods: In incident CAPD patients (n = 90; 62 men, 28 women), LVH was evaluated by electrocardiography (ECG) Romhilt–Estes score. Resting clinic-casual HR was also measured.
Results: Patients were divided into four groups, according to Romhilt–Estes score: group 1 (LVH group), ≥5; group 2, 3 – 5; group 3, 1 – 3; group 4, 0 – 1. The HR in group 1 (95.9 ± 18.1 bpm) was significantly higher than that in groups 2 (81.8 ± 14.4 bpm), 3 (82.5 ± 15.8 bpm), and 4 (83.3 ± 11.5 bpm). The ECG LVH was positively associated with HR (r = 0.244, p = 0.021) and Ca×P product (r = 0.293, p = 0.022). In a multivariate regression analysis, ECG LVH was independently associated with HR (p = 0.015) and Ca×P product (p = 0.016).
Conclusions: HR and Ca×P product were closely associated with an increased ECG LVH, even after adjustment for confounders. This suggests that commonly recognized resting clinic-casual HR is useful also in predicting CVD in CAPD patients.
Impact of Weight and Body Fat Distribution on Carotid Atherosclerosis in Chronic Peritoneal Dialysis Patients
Objectives: Previous studies reported that increasing body size (BMI) is correlated with a decreased mortality risk in dialysis patients. However, obesity is one of the most important factors contributing to the development of systemic atherosclerosis. The present study investigated effects of weight and body fat distribution on multiple risk factors and carotid atherosclerosis in chronic peritoneal dialysis (PD) patients.
Methods: A total of 81 PD patients were divided into four groups by body mass index (BMI) and waist–hip ratio (WHR): abdominal obesity (AOb)—BMI ≥ 25, WHR ≥ 0.9; peripheral obesity (POb)—BMI ≥ 25, WHR < 0.9; metabolic obese normal weight (MOb)—BMI < 25, WHR ≥ 0.9; normal control (Ctrl)—BMI< 25, WHR < 0.9. Patients underwent a carotid artery examination by high-resolution B-mode ultrasonography. Flow variables were collected: systolic (SBP) and diastolic (DBP) blood pressure, fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), and C-reactive protein (CRP).
Results: Compared with the other groups, the AOb group exhibited a higher prevalence and extent of carotid atherosclerosis: intima media thickness (IMT), 0.67 ± 0.25 mm versus 0.56 ± 0.19 mm, 0.536 ± 0.21 mm, and 0.50 ± 0.17 mm (p < 0.05); plaque score (PS), 1.77 ± 0.53 versus 1.49 ± 0.41, 0.95 ± 0.41, and 0.94 ± 0.39 (p < 0.05). There were significantly positive correlations between WHR, IMT, PS, and TG (p < 0.05). Multiple linear regression analysis showed WHR to be a significant independent risk factor for the increase of carotid atherosclerosis and lipid abnormalities.
Conclusions: Fat distribution is associated with the prevalence of carotid atherosclerosis and lipid abnormalities in chronic PD patients.
Influence of Peritoneal Dialysis Adequacy, Nutrition Status, Left Ventricular Hypertrophy on Cardiovascular Disease in Peritoneal Dialysis Patients
Objectives: To evaluate the possible risk factors for cardiovascular disease (CVD) in peritoneal dialysis (PD) patients.
Methods: The present study was designed to estimate the relationship between small-solute clearance, indices of nutrition, and CVD episodes in PD patients. Peritoneal equilibration test (PET), indices of inflammation and nutrition, and small-solute clearance [Kt/V, creatinine clearance (CCr)] were examined every 6 months. We defined CVD events as myocardial infarction, angina, coronary artery bypass graft or angioplasty, transient ischemic attack or cardiovascular accident, peripheral vascular disease, and congestive heart failure. Symptoms and signs were collected from history. Left ventricular hypertrophy (LVH) was detected by cardiac ultrasonography.
Results: The study enrolled 254 patients [mean age: 56 years; mean follow-up: 49 months; 144 patients with no CVD events, 110 patients with a history of a CVD event or events (pre-existing CVD)]. During follow-up, the overall incidence of CVD events was 37% (93/245). Risk factors for the overall incidence of CVD were CCr, Kt/V, albumin, pre-albumin, triglycerides, and duration of PD. Statin administration could significantly reduce the risk of CVD events. In patients without pre-existing CVD, predictors of new CVD events were diabetes, hypoalbuminemia, and hypo–pre-albuminemia. However, in pre-existing CVD patients, higher triglycerides, and higher left atrial end systolic diameter, left ventricular septum thickness, and left ventricular mass index (LVMI) at baseline were predictors of progression of CVD. Kaplan–Meier curves showed CVD at baseline was the dependent risk for mortality. Compared with albumin ≥ 33 g/dL, albumin < 33 g/dL had a markedly greater association with CVD events (p < 0.01). Also, LVMI > 159.6 g/m2 was accompanied by an increased risk in progression of CVD events.
Conclusions: In PD patients, CVD is a common morbidity. More attention should be paid to timely detection. Statin drugs are associated with a decline in CVD events. Serum albumin, small-solute clearance, and LVH were the important determinants of CVD events in PD patients.
Factors Associated with Cardio-/Cerebrovascular Diseases in Patients on Peritoneal Dialysis
Objective: Cardiovascular and cerebrovascular complications, including congestive heart failure, cerebrovascular disease, and myocardial infarction, are the major cause of morbidity and mortality among patients on peritoneal dialysis (PD). This study investigated the risk factors for cardio-/cerebrovascular diseases in patients on PD.
Methods: A total of 265 patients with complete follow-up data who initiated PD treatment during January 2002 – December 2008 in our center were divided into three groups: group 1, no cardio-/cerebrovascular diseases; group 2, cardio-/cerebrovascular diseases present before PD treatment; group 3, development of cardio-/cerebrovascular diseases since PD start. Data on patient body weight, hemoglobin (Hb), albumin (Alb), triglycerides (TG), total cholesterol (TC), lipoprotein(a) [Lp(a)], high-sensitivity C-reactive protein (hs-CRP), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), and ejection fraction (EF), if combined with diabetes or hypertension, were collected.
Results: Of the study patients, 72.1% had cardio-/cerebrovascular diseases, including 113 patients in group 2 and 78 patients in group 3. By the end of March 2009, 70 patients had died, with 26 patients (37.1%) dying of cardio-/cerebrovascular diseases. In groups 2 and 3, 77 patients (40.3%) had diabetes, and 163 patients (85.3%) had hypertension; in group 1, 5 patients (6.8%) had diabetes, and 47 patients (63.5%) had hypertension. In the three groups, Hb was 96.3 ± 20.3 g/L, 86.9 ± 21.4 g/L, and 86.5 ± 18.8 g/L respectively (p < 0.05); Alb was 31.2 ± 6.3 g/L, 27.2 ± 5.4 g/L, and 27.4 ± 5.6 g/L (p < 0.01); hs-CRP was 11.9 ± 6.9 g/L, 23.6 ± 14.2 g/L, and 15.4 ± 9.6 g/L (p < 0.01). Logistic regression analysis showed that diabetes, catheter insertion age, and EF were risk factors for cardio-/cerebrovascular diseases in PD patients.
Conclusions: Cardio-/cerebrovascular diseases are frequent complications in patients on PD, and are associated with diabetes, hypertension, anemia, decreased serum albumin, and increased hs-CRP. Diabetes, advanced age for catheter insertion, and decreased EF are risk factors for cardio-/cerebrovascular diseases in patients initiating PD treatment. These risk factors should be treated to improve survival in PD patients.
Arterial Stiffness in Peritoneal Dialysis Patients Compared with Pre-dialysis and Hemodialysis Patients
Objectives: Arterial stiffness is one of the major complications in chronic kidney disease (CKD). Recently, a handy device for monitoring augmentation index (AIx) in the radial artery was introduced, allowing for the use of AIx in the evaluation of artery stiffness. This study investigated the association between glomerular filtration rate (GFR) and AIx in CKD and observed the effect of dialysis on arterial stiffness.
Methods: Our study included 62 stable continuous ambulatory peritoneal dialysis (CAPD) patients, 56 patients on maintenance hemodialysis (HD), and 122 pre-dialysis CKD patients. All patients were nondiabetic, and the groups were comparable in age and sex. Radial AIx was evaluated by a newly introduced applanation tonometer. Clinical data including sex, age, height, weight, body mass index, primary disease, residual renal function, and dialysis prescription were collected from in-patient case histories and the dialysis data base.
Results: Among both pre-dialysis and dialysis patients, women had higher AIx than did men (24.8% ± 9.3% vs. 18.2% ± 10.9%, p < 0.01). In addition, AIx was significantly higher in patients more than 65 years of age and in patients with uremia requiring more than 1 antihypertensive drug (p < 0.05). Radial AIx was negatively correlated with GFR in pre-dialysis CKD patients (p < 0.05). However, patients on CAPD or HD a had better AIx than did pre-dialysis CKD5 patients [19.8% ± 10.9% and 19.7% ± 9.4% respectively vs. 25.3% ± 10.1%,p < 0.05), indicating that dialysis may improve arterial stiffness. No difference in AIx was found between CAPD and HD patients.
Conclusions: Our study demonstrates that arterial stiffness progresses with deterioration of renal function in CKD patients, suggesting the important roles of renal failure or metabolic alterations secondary to renal failure (or both) in arterial stiffness. No adverse effect of CAPD or HD was observed. On the contrary, our observation indicates that both peritoneal dialysis and HD can improve arterial stiffness in patients with uremia.
Risk Factors for Cardiovascular Diseases in Peritoneal Dialysis Patients
Objectives: Atherosclerotic cardiovascular disease (ASCVD) is an important prognostic factor in dialysis patients. To investigate the risk factors for cardiovascular disease in peritoneal dialysis patients.
Methods: The study included 113 patients who initiated continuous ambulatory peritoneal dialysis in Changzheng hospital for more than 1 year. In 78 cases, the patients had left ventricular hypertrophy, heart failure, angina, or ventricular arrhythmia. The patients were divided into two groups: those with cardiovascular diseases before PD, and those whose cardiovascular disease developed in the course of PD. Blood pressure, residual renal function (RRF), Kt/V, peritoneal equilibration test (PET), hemoglobin, albumin, parathyroid hormone, C-reactive protein, diabetes status, and other patient parameters were recorded.
Results: Cardiovascular complications occurred in 78 patients of 113 patients, for an incidence rate of 69.0%. Of the 78 patients, 24 had cardiovascular diseases before PD (30.8%). In the other 54 patients, hemoglobin was 93.2 ± 28.5 g/L, RRF was 2.02 ± 2.8 mL/min, Kt/V was 1.72 ± 0.37, PET was 0.78 ± 0.25, and albumin was 30.1 ± 7.9 g/L. Logistic regression analysis showed that diabetes, RRF, and anemia were independent risk factors for cardiovascular complications. There were no statistical differences between the groups in inflammation indicators, CRP, hyperlipidemia, hypoalbuminemia, and cardiovascular complications.
Conclusions: Peritoneal dialysis patients have a high incidence of cardiovascular complications. High blood pressure, less RRF, diabetes, anemia, hyperlipidemia, C-reactive protein, and other factors are related to cardiovascular complications. Diabetes, RRF, and anemia are independent risk factors for cardiovascular complications. Intervening in the above-mentioned factors in peritoneal dialysis patients may reduce the incidence of cardiovascular complications, and improve the survival rate.
Study of Cardiovascular Function in New Peritoneal Dialysis Patients with End-Stage Diabetic Nephropathy
Objectives: To evaluate cardiovascular system status in end-stage renal disease (ESRD) patients beginning peritoneal dialysis (PD) with the underlying disease of diabetes mellitus.
Methods: Our study recruited 165 patients on PD between November 2001 and January 2008 [mean age: 47.5 years (range: 14–78 years)]. Of the 165 patients, 25 (15.2%) had diabetic nephropathy (DN). Clinical data including blood pressure, body mass index, cardiothoracic ratio, hemoglobin, serum creatinine, albumin, and urine volume were collected before dialysis.
Results: All ESRD patients had cardiac abnormalities, including left ventricular hypertrophy and interventricular septum thickening, before dialysis. There were significant differences between patients with and without DN in cardiothoracic ratio (0.528 ± 0.06 vs. 0.466 ± 0.06, p < 0.05), left atrial diameter (37.5 ± 5.84 mm vs. 34.98 ± 5.64 mm, p < 0.05), hemoglobin (7.4 ± 1.53 g/dL vs. 8.3± 2.03 g/dL, p < 0.05), albumin (33.6 ± 5.15 g/L vs. 36.1 ± 5.9 g/L, p < 0.05), complications of hypertension (100% vs. 78.7%).
Conclusions: Pathologic abnormalities are prevalent in ESRD patients, especially in those whose ESRD is caused by diabetes mellitus. A cardiac sonogram should be performed in these patients to assess the cardiovascular system.
Relationship between Nutrition and Arterial Stiffness in Patients Undergoing Peritoneal Dialysis
Objectives: Malnutrition is a predictor of cardiovascular disease in patients undergoing peritoneal dialysis (PD). However, it is not sure whether there is a relationship between nutrition and arteries in PD patients. This study observed the relationship between nutrition and stiffness of conducting arteries in continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: We selected 40 clinically stable CAPD patients at the same center. The stiffness of the carotid and femoral arteries was evaluated by pulse wave velocity using an automatic pulse wave analyzer. Nutrition status was evaluated by subjective global assessment (SGA) and serum albumin. The SGA included the degree of the patient's weight loss, dietary changes, gastrointestinal symptoms, and the degree of muscle wasting, edema, and loss of subcutaneous fat. At the same time, standard biochemical measurements were taken.
Results: Using SGA scores, the patients were assigned to two groups: the well-nourished and the malnourished. The pulse-wave conduction velocity for patients in the malnourished group was significantly higher than it was for patients in the well-nourished group (p < 0.01). Pearson correlation analysis showed that pulse-wave conduction velocity was negatively correlated with serum albumin (r = –0.501, p < 0.001) and positively correlated with diabetes status (r = 0.659, p < 0.001) and systolic blood pressure (r = 0.480, p < 0.01).
Conclusions: There is an obvious correlation between various indices of nutrition and aortic stiffness in CAPD patients. Malnutrition can promote abnormalities of the blood vessels, resulting in an increasing incidence of cardiovascular disease and mortality.
Relationship between Serum Uric Acid and Cardiovascular Disease in Patients Undergoing Peritoneal Dialysis
Objectives: Uric acid is the metabolic end product of purine. The higher incidence of cardiovascular disease (CVD) in patients undergoing peritoneal dialysis (PD) may be related to an increased level of serum uric acid. In this study, we assayed uric acid and other markers to analyze their relationship with CVD in continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: In this cross-sectional study, we measured body mass index (BMI), concentrations of plasma lipoproteins, hemoglobin, albumin, serum creatinine and Kt/V, blood pressure (BP), and incidence rate of CVD in 66 hyperuricemic CAPD patients (experimental group) and 52 CAPD patients with normal serum uric acid (control group).
Results: Compared with controls, the hyperuricemic CAPD patients had higher BMI (p < 0.05), triglycerides (TGs: p < 0.01), low-density lipoprotein (LDL: p < 0.01), and serum creatinine (p < 0.01), and lower albumin (p < 0.05), hemoglobin (p < 0.05), and Kt/V (p < 0.05). Incidence rates of CVD and hypertension were significantly higher in the experimental group than in the control group. Serum uric acid was positively correlated with creatinine (r = 0.15, p < 0.01), TGs (r = 0.09, p < 0.05), LDL (r = 0.19, p < 0.05), systolic BP (r = 0.13, p < 0.05), and diastolic BP (r = 0.13, p < 0.05).
Conclusions: The increased incidence of CVD in hyperuricemic CAPD patients may be caused by a higher level of serum uric acid.
Risk Factors for Left Ventricular Hypertrophy in Continuous Ambulatory Peritoneal Dialysis Patients
Objectives: Left ventricular hypertrophy (LVH) is a critical and an independent factor for mortality of patients with end-stage renal disease, and numerous risk factors for LVH have been discussed in previous studies. In the present study, we intended to clarify the factors that affect the progression of LVH in patients on continuous ambulatory peritoneal dialysis (CAPD) and to analyze the influences of those risk factors on the severity of LVH.
Methods: Our study retrospective enrolled 26 CAPD patients who underwent echocardiography before and after CAPD start (14 men, 12 women; mean age: 46 ± 16 years; mean follow-up: 22.5 ± 5.1 months). We estimated the change of LVH by calculating the difference in left ventricular mass index (LVMI) on echocardiography. We also analyzed factors that may influence the change of LVMI: age, sex, blood pressure (BP), hematocrit, calcium, phosphate, intact parathyroid hormone (iPTH), serum albumin, and peritoneal transport status on peritoneal equilibration test (PET).
Results: The LVMI was positively correlated with mean systolic BP (r = 0.391, p < 0.01) and negatively correlated with mean hematocrit (r = –0.4201, p < 0.05). Also, the LVMI was higher in high transporters than in low transporters (158 ± 32 g/m2 vs. 123 ± 42 g/m2), but the difference was not statistically significant (p > 0.05). Using multivariate analysis, systolic BP was significantly and independently associated with increased LVMI.
Conclusions: The factors necessary to restrict the progression of LVH after initiation of CAPD are strict BP control and correction of anemia. Differences in peritoneal transport properties are associated with the development of hypertension and LVH.
Increased Visceral Fat Mass is Associated with Peripheral Arterial Disease in Continuous Ambulatory Peritoneal Dialysis Patients
Objectives: Peripheral arterial disease (PAD) is a common atherosclerotic disease in dialysis patients that damages quality of life and increases mortality in this population. Although the role of obesity in the outcome of dialysis patients is still in debate, the recent literature has indicated that increased visceral fat mass plays a destructive role in the atherosclerotic process. Therefore, in the present study, we investigated the role of visceral fat mass in the prevalence of PAD in continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: Our study included CAPD patients visiting the outpatient clinic of our hospital between January 2008 and July 2008. We determined PAD using ankle brachial index (ABI). Visceral fat was determined using multiple-frequency bioelectric impedance analysis (BIA). Nutrition status was evaluated by subjective global assessment (SGA), and endothelial function by brachial-artery flow-mediated dilation (FMD) using an ultrasound device. The patients were divided into four groups based on nutrition status and visceral fat mass, and then the prevalence of PAD was compared between the groups.
Results: The prevalence of PAD was significantly higher in patients with a high visceral fat mass and in malnourished patients as compared with their respective counterparts: 70.6% in malnourished patients with high visceral fat mass, 42.3% in malnourished patients with low visceral fat mass, 29.5% in well-nourished patients with high visceral fat mass, and 12.5% in well-nourished patients with low visceral fat mass. Patients with high visceral fat mass were also older than and had more endothelial dysfunction than did patients with low visceral fat mass.
Conclusions: Visceral fat mass and malnutrition might have a synergetic effect on atherosclerosis and PAD in CAPD patients.
Close Association between Arterial Stiffness and Volume Overload in Continuous Ambulatory Peritoneal Dialysis Patients
Objectives: Volume overload and arterial stiffness are both common in continuous ambulatory peritoneal dialysis (CAPD) patients. In the present study, we investigated whether there is a relationship between volume overload and stiffness in large arteries in CAPD patients.
Methods: Clinical stable CAPD patients (n = 220; 86 men, 134 women) in a single center were included. The volume status in these patients was evaluated monthly for 6 months with multi-frequency bioelectrical impedance analysis. The patients were then divided into a normal-volume group (NV: n = 94), and intermittently volume-overloaded group (IVO: n = 79), and a continuously volume-overloaded group (CVO: n = 47). Carotid and femoral artery pulse wave velocity (PWV) was measured and used as an index of stiffness in large arteries. Blood biochemistry was determined using standard methods. We analyzed the change of large-artery stiffness and its association with volume status.
Results: At baseline, systolic blood pressure was significantly different between the three groups, with the CVO group having the highest readings, and the NV group, the lowest. After 6 months, systolic blood pressure showed the same differences between the three groups. In the IVO and CVO groups, PWV was significant higher than it was in the NV group (both p < 0.01). Serum albumin was significantly higher in the NV group than in the IVO and CVO groups (both p < 0.05). During the 6-month follow-up, no significant changes occurred in any parameter in the NV group, but PWV increased significantly in the IVO and CVO groups alike (p < 0.05, p < 0.01 respectively). Serum albumin decreased significantly (p < 0.05) in the CVO group, and high-sensitivity C-reactive protein increased significantly in the IVO and CVO groups (both p < 0.05).
Conclusions: Continuous volume overload is strongly associated with stiffness of the large arteries in CAPD patients, possibly because of its effect on blood pressure, inflammation, and nutrition status.
Effect of Different Blood Pressure Subtypes on Cardiac Remodeling in Patients on Continuous Ambulatory Peritoneal Dialysis
Objectives: A previous study showed that isolated systolic hypertension (ISH) is associated with a higher risk of stroke than is isolated diastolic hypertension (IDH) or systolic–diastolic hypertension (SDH). However, little is known about the effect of various blood pressure (BP) subtypes on cardiac remodeling.
Methods: This cross-sectional study enrolled 190 continuous ambulatory peritoneal dialysis (CAPD) patients (mean age: 62 ± 13 years; average dialysis vintage: 16 months) from a single center. The patients were divided into four subgroups according to office-measured brachial artery BP: normotension group—systolic/diastolic BP (SBP/DBP) < 140/90 mmHg, n = 84; ISH group—SBP ≥ 140 mmHg and DBP < 90 mmHg, n = 58; SDH group—SBP ≥ 140 mmHg and DBP ≥ 90 mmHg, n = 48; and IDH group—SBP < 140 mmHg and DBP ≥ 90 mmHg, n = 0. The height (meters2.7)–standardized left ventricular mass index (LVMI) was measured by echocardiography and used to judge left ventricular hypertrophy (LVH). Both LVMI and LVH were used to evaluate cardiac remodeling.
Results: There were no significant differences in age, sex, body mass index, diabetes status, urine, indices of dialysis adequacy, and antihypertensive medication between the ISH, SDH, and normotension subgroups. The height-standardized LVMI was significantly higher in the ISH and SDH groups than in the normotensive group (61.2 ± 25.9 g/m2 vs. 65.2 ± 24.7 g/m2 vs. 47.9 ± 21.3 g/m2), but there was no significant difference between the ISH and SDH groups. Similarly, the prevalence of LVH was significantly higher in the ISH and SDH groups than in the normotensive group (60.3% vs. 70.2% vs. 37.8%, p < 0.01). In logistic regression analysis, ISH and SDH, as compared with normotension, were related to a heightened risk of developing LVH (by a factor of 2.2 and 2.4 respectively).
Conclusions: In CAPD patients, the ISH and SDH BP subtypes had a higher LVMI and prevalence of LVH, indicating a higher risk of cardiac remodeling in these patients.
Changes in Structure and Function of the Heart and other Related Risk Factors in Peritoneal Dialysis Patients
Objectives: To evaluate the effects of peritoneal dialysis on the structure and function of the heart and to analyze other related risk factors in peritoneal dialysis patients.
Methods: The study included 40 patients with chronic kidney disease (CKD) stage 5 on peritoneal dialysis for more than 3 months with a weekly Kt/V above 1.5 (group A); 44 patients in the same stage not on dialysis (group B); and 40 healthy people (group C). Blood pressure was measured in all patients, and total protein (TP), albumin (ALB), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), serum creatinine (sCr), hemoglobin (Hb), and low-density lipoprotein (LDL) were also tested. Left atrial end systolic diameter (LAD), left ventricular end-diastolic volume (LVDd), left ventricular end-systolic volume (LVDs), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), ejection fraction (EF), E/A were determined using echocardiography.
Results: Compared with group B, group A had a lower IVST (p < 0.05) and LVPWT (p < 0.01). Diastolic heart function showed no improvement. There was no significant difference between the three groups. Compared with group B, group A had a higher ALB (p < 0.05) and Hb (p < 0.01), lower sCr, systolic blood pressure (SBP), diastolic blood pressure (DBP), TG, and TC (p < 0.01). The sCr, SBP, and DBP were positively correlated with LAD (r = 0.579, 0.576, 0.478; p < 0.01); LVDd was negatively correlated with Hb (r = –0.334, p < 0.05) and positively correlated with sCr and SBP (r = 0.42, 0.379; p < 0.05); LVDs was correlated with sCr and SBP (r = 0.516, 0.431; p < 0.01); IVST and LVPWT were correlated with sCr (r = 0.415, 0.365; p < 0.01) and SBP (r = 0.363, 0.361; p < 0.05); and EF was correlated with sCr (r = –0.325, p < 0.05).
Conclusions: Patients in CKD stage 5 showed no improvement in diastolic function of the heart after peritoneal dialysis therapy, but did show significant changes of IVST and LVPWT. There were no significant differences between the three groups. The highest correlation was between sCr and heart injury, making sCr is the most important factor in the process; decreases in sCr and blood pressure, and elevation of Hb can reduce cardiac complications in CKD stage 5 patients, improving their survival rate and quality of life.
Unstable Trend of Total Fluid Removal is a Strong Predictor for De Novo Cardiovascular Diseases in Patients on Chronic Peritoneal Dialysis
Objectives: Total fluid removal (TFR) is the sum of daily urine and ultrafiltration. A strong protective effect of a non-declining trend of TFR on cardiovascular (CV) mortality has been documented previously at our center. Whether an unstable trend of TFR during peritoneal dialysis (PD) therapy has an adverse effect on de novo CV disease (CVD) is unknown.
Methods: Our single-center observational cohort study of 222 incident adult PD pts [median age: 62.5 years; 88 (39.6%) men; 94 (42.3%) with diabetes (DM); 147 (66.2%) with a CVD before PD start] was begun in December 2002 and completed in February 2008. Complete data for all participants—sex, age, body mass index, pre-PD CVD history, DM, baseline systolic and diastolic blood pressure (BP: average level from the 2nd to the 4th month after PD start), consumption of antihypertensives, biochemical indices (hemoglobin, albumin, Ca×P product, and lipids), first dialysis adequacy indices, and residual renal function—were available for the first half year. Records of TFR were averaged in the first 2 – 4 months after PD start for a baseline. Mean values of TFR at each 3-month interval thereafter were recorded. For each pt, TFR was regressed against time, and the TFR change rate (TFRCR—milliliters per time interval) was calculated. Patients were classified by TFRCR tertile. De novo CVD was defined as the first CVD event [heart disease (ischemic heart disease, congestive heart failure, arrhythmia, and pericarditis, among others), cerebrovascular disease, and peripheral vascular disease] since PD therapy start. The time of the de novo CVD was recorded. Multivariate Cox regression models (backward selection) were used to calculate predictive factors for de novo CVD.
Results: Mean BP was 138/80 mmHg. TFRCR ranged from –183.33 mL to 100.30 mL per 3-month interval. Tertiles of TFRCR per 3-month interval were –183.33 mL to –10.51 mL (group I), –10.47 mL to 2.30 mL (group II), and 2.34 mL to 100.30 mL (group III). With group II as reference, and after adjustment for DM, albumin, Ca×P, triglycerides, TFRCR group I [hazard ratio (HR): 1.93; 95% confidence interval (CI): 1.00 to 3.73; p = 0.049] and group III (HR: 2.06; 95% CI: 1.07 to 3.96; p = 0.030) were associated with de novo CVD. Merging groups I and III as group B (pts with unstable TFR trend), and using group II as group A (pts with stable TFR) as the reference, pts in group B had a 95% increased risk for de novo CVD (HR: 1.95; 95% CI: 1.09 to 3.49; p = 0.024) after adjustment for DM, albumin, and triglycerides.
Conclusions: An unstable TFR trend was associated with increased risk of de novo CVD. Keeping a constant TFR should be the main task in managing pts on chronic PD.
Sleep Apnea is an Independent Risk Predictor for All-Cause and Cardiovascular Mortality in Peritoneal Dialysis Patients
Sleep apnea is increasingly being recognized to be highly prevalent in dialysis patients. However, the prognostic implication of sleep apnea in this population is not known. We prospectively followed clinical outcome in continuous ambulatory peritoneal dialysis (PD) patients who were recruited into our Sleep Apnea in PD Patients program over 10 years. Baseline comprehensive overnight polysomnography (PSG) was performed in 93 PD subjects (mean age: 56 ± 15 years; 52% men). Significant sleep apnea, defined as an apnea-hypopnea index (AHI—frequency of apnea and hypopnea per hour of sleep) of ≥15/h, was present in 51 subjects (55%). During a mean follow-up of 47.8 ± 27 months (range: 2.2 – 117.2 months), 30 deaths occurred (32%), of which 13 (43%) were attributable to cardiovascular causes. Cardiovascular mortality was 69% and 31% respectively (p < 0.05) for patients with and without sleep apnea over the follow-up period. Using Kaplan–Meier analysis for the entire follow-up duration, patient survival was significantly higher in patients with a baseline AHI below 15/h (71% vs. 36%, p = 0.017). Multivariate Cox regression analysis showed that the presence of significant sleep apnea was predictive of increased all-cause mortality [hazard ratio (HR): 3.50; 95% confidence interval (CI): 1.32 to 6.76; p < 0.05) and cardiovascular death (HR: 6.1; 95% CI: 3.37 to 16.48; p < 0.05).
Causes of Large-Artery Stiffness in Continuous Ambulatory Peritoneal Dialysis Patients
Objectives: Stiffness in the large arteries is a common complication of peritoneal dialysis (PD). This study investigated the factors that cause large-artery stiffness in continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: Our study included 251 clinically stable CAPD patients from a single center (131 men, 138 women). Carotid and femoral artery pulse wave velocity (PWV) as measured with a validated automated device was used as an index of large-artery stiffness. In addition, serum albumin, C-reactive protein, serum creatinine, serum triglycerides, total cholesterol, and lipoprotein were determined using standard methods. Pearson correlation and multiple regression analysis were performed to identify relationships between measured factors and PWV.
Results: PWV was strongly associated with diabetes mellitus (DM), age, systolic blood pressure (SBP), and sex. Multiple regression analysis showed that PWV was independently determined by DM (1 Yes, 0 No; β = 0.352; p = 0.001), age (β = 0.367, p = 0.001), SBP (β = 0.231, p = 0.001), and sex (1 female, 0 male; β = –0.123, p = 0.020). These factors accounted for 60.4% of the total variance.
Conclusions: DM, age, SBP, and sex are independent determinants of large-artery stiffness in CAPD patients.
Effects of Peritoneal Dialysis on Asymmetric Dimethylarginine Expression in End-Stage Renal Disease Patients
Objectives: Patients with end-stage renal disease (ESRD) have high mortality, and cardiovascular disease (CVD) is the primary cause of death in ESRD patients. Asymmetric dimethylarginine (ADMA) has been recognized as the single risk factor in cardiovascular disease in recent years. ADMA is an inhibitor of endothelial nitric oxide synthase (eNOS) and reduces the production of NO. It can therefore damage vascular endothelial function and enhance the incidence of CVD. This study investigated the correlation of plasma ADMA and disturbance of endothelial function in ESRD patients, and evaluated the value of ADMA removed by peritoneal dialysis (PD) treatment.
Methods: Our study enrolled 63 ESRD patients, who were divided into two groups: a PD treatment group (n = 30), and a conservative uremia treatment group (n = 33). We enrolled 32 healthy adults as a control group. Age and sex were matched in the three groups. We used high-performance liquid chromatography analysis to measure ADMA in early morning plasma and PD fluid. Serum eNOS was measured by ELISA. The results were analyzed using statistical software.
Results: Plasma ADMA was significantly higher in the ESRD patients (including the conservative treatment group and the PD group) than in the control group (p < 0.05). Plasma ADMA was significantly lower in the PD group than in the conservative treatment group (p < 0.05). Plasma ADMA was significantly higher in ESRD patients with hypertension than in ESRD patients with normal blood pressure (p < 0.05). Serum eNOS was lower in ESRD patients than in the control group. The eNOS level was lower in the PD treatment group than in the control group.
Conclusions: Our study suggests that the endothelial function disturbance in ESRD patients is related to accumulation of plasma ADMA. Plasma ADMA is a risk factor for CVD in ESRD patients. It can be used as a predictor of CVD. Peritoneal dialysis treatment can partly remove plasma ADMA.
Effects of Peritoneal Dialysis on Plasma Homocysteine and Nitric Oxide in Uremia Patients
Objectives: Homocysteine (Hcy) is a nonessential amino acid that has recently been considered an independent risk factor for cardiovascular disease (CVD). Hyperhomocysteinemia is related to CVD and mortality in end-stage renal disease (ESRD) patients. Peritoneal dialysis (PD) can reduce Hcy levels in uremia patients. This study explored the effects of PD on plasma Hcy and NO expression in uremia patients.
Methods: The ESRD patients in the study were divided into two groups: a non-dialysis group and a continuous ambulatory PD (CAPD) group. No patient had dominant edema, peritoneal or another infection, and serious heart failure, gastrointestinal bleeding, active liver disease, cancer, trauma, or surgery. Healthy people were chosen as control group. They underwent medical examination to exclude infection, hyperlipidemia, hypertension, diabetes, cardiovascular and cerebrovascular diseases, and liver and kidney disease. The three groups were matched for age and sex. The plasma and serum of patients and healthy controls were collected. Levels of Hcy in plasma and PD fluid were measured by high-performance liquid chromatography analysis. Plasma NO levels were measured by enzyme nitrate reduction.
Results: Plasma Hcy was 8.73 ± 1.20 μmol/L in the control group; 45.10 ± 15.65 μmol/L in the non-dialysis group; and 35.96 ± 16.86 μmol/L in the CAPD group. Hcy in PD fluid was 9.76 ± 7.25 μmol/L. Hcy was higher in the non-dialysis and CAPD groups than in the control group (p < 0.01). Hcy was higher in the non-dialysis group than in the CAPD group (p < 0.05). Plasma Hcy was higher in the non-dialysis group with hypertension than in group members with normal blood pressure, and the difference between those two subgroups was statistically significant (p < 0.01). Plasma Hcy was higher in the CAPD patients with hypertension than in those with normal blood pressure, and the difference between those two subgroups was statistically significant (p < 0.01). High-sensitivity C-reactive protein (hs-CRP) was higher in the non-dialysis and CAPD groups than in the control group (p < 0.01), and hs-CRP was higher in the CAPD group than in the non-dialysis group (p < 0.05). Serum NO was higher in the non-dialysis and CAPD groups than in the control group (p < 0.01). Furthermore, serum NO was lower in the CAPD group than in the non-dialysis group, but the difference was nonsignificant (p > 0.05).
Conclusions: Peritoneal dialysis can remove plasma Hcy in uremic patients and tends to reduce serum NO in those patients.
Investigation of Cardio-/Cerebrovascular Complications in Continuous Ambulatory Peritoneal Dialysis Patients
Objectives: To investigate the conditions of cardio-/cerebrovascular complications in patients with end-stage renal failure (ESRF) on continuous ambulatory peritoneal dialysis (CAPD), and to uncover the primary problems in patients on CAPD and provide a basis for early intervention.
Methods: Our study enrolled 72 patients with ESRF on CAPD from July 2004 to December 2007. Blood biochemical examinations and peritoneal dialysis adequacy were recorded. The genesis, development, and prognosis of cardiovascular disease (CVD) events and their related factors were analyzed using carotid and cardiac ultrasonography, computed tomography imaging and other investigative methods.
Results: Mean follow-up for the patients was 37 months, during which time 31 new cases of cardio-/cerebrovascular events, deterioration from original events, or deaths from cardio-/cerebrovascular causes were checked, for an incidence rate of 43% (31/72). Seven patients died, 2 from ventricular hemorrhage. Cardiac ultrasonography showed higher values for left atrial end systolic diameter, left ventricular systolic twist, and left ventricular mass index in the patients with cardio-/cerebrovascular events. In this group, intima media thickening (IMT), widening of the carotid artery diameter, and decreases in systolic peak velocity and diastolic velocity (DV) were prevalent. Statistical data showed that, in addition to DV and IMT, plasma cholesterol, dialysis vintage, peritonitis, and serum triglycerides, uric acid, albumin, P, and Ca were independent risk factors for CVD events. During follow-up, we noted significant differences between the group without previous or new CVD events and the group of patients with new CVD events, not only in serum albumin level, but also in creatinine clearance and Kt/V. During follow-up, compared with the group without the foregoing symptoms, patients with prior CVD events, longer dialysis vintage, and higher serum triglycerides may be associated with CVD events. During follow-up, the survival rate was lower in patients with a serum albumin below 33 g/dL; the survival rate was also lower in patients with peritonitis.
Conclusions: Patients with ESRF on CAPD are at higher risk for CVD. The most important intervention measures are maintenance of peritoneal dialysis adequacy, reduction of the toxic effects of uremia, and avoidance of peritonitis episodes.