Clinical Studies of Interventions to Mitigate Cardiovascular Risk in Peritoneal Dialysis Patients.

Abstract

Cardiovascular disease (CVD) is highly prevalent in the peritoneal dialysis (PD) population, affecting up to 60% of cohorts. CVD is the primary cause of death in up to 40% of PD patients in Australia, New Zealand, and the United States. Cardiovascular mortality rates are reported to be approximately 14 per 100 patient-years, which are 10- to 20-fold greater than those of age- and sex-matched controls. The excess risk of CVD is related to a combination of traditional risk factors (such as hypertension, dyslipidemia, obesity, smoking, sedentary lifestyle, and insulin resistance), nontraditional (kidney disease-related) risk factors (such as anemia, chronic volume overload, inflammation, malnutrition, hyperuricemia, and mineral and bone disorder), and PD-specific risk factors (such as dialysis solutions, glycation end products, hypokalemia, residual kidney function, and ultrafiltration failure). Interventions targeting these factors may mitigate cardiovascular risk, although high-level clinical evidence is lacking. This review summarizes the evidence relating to cardiovascular interventions targeting modifiable CVD risk factors in PD patients, as well as highlighting the key recommendations of the International Society for Peritoneal Dialysis Cardiovascular and Metabolic Guidelines.

• Authors: Dev Jegatheesan, Yeoungjee Cho, David W Johnson
• Journal: Seminars in nephrology (Semin Nephrol) Vol. 38 Issue 3 Pg. 277-290 (May 2018) ISSN: 1558-4488 [Electronic] United States
• PMID: 29753403 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Dialysis Solutions
• Glycated Hemoglobin A
• hemoglobin A1c protein, human

Topics

• Anemia (drug therapy)
• Cardiovascular Diseases (etiology, prevention & control)
• Chronic Kidney Disease-Mineral and Bone Disorder (drug therapy)
• Depression (therapy)
• Dialysis Solutions (therapeutic use)
• Dyslipidemias (drug therapy)
• Exercise
• Glycated Hemoglobin (metabolism)
• Humans
• Hyperglycemia (blood, prevention & control)
• Hypertension (physiopathology, therapy)
• Inflammation (drug therapy)
• Kidney Failure, Chronic (physiopathology, therapy)
• Obesity (therapy)
• Peritoneal Dialysis (methods)
• Practice Guidelines as Topic
• Risk Factors
• Smoking Cessation