Cardiovascular risk in peritoneal dialysis.
All patients with CKD have multiple risk factors for CVD and CAD in particular. Some of these risk factors such as age and gender cannot be modified. Others such as diabetes and hypertension are not only CVD risk factors but are also the cause of the patient's CKD. Finally there are a group of risk factors such as disturbances of mineral metabolism and oxidative stress which are present either uniquely in or are exaggerated by renal failure. PD gives patients a more atherogenic lipid and lipoprotein profile, puts them at greater risk for AGE formation and usually causes hyperinsulinemia. All of these contribute to CVD risk. However, they can also achieve excellent blood pressure control, usually easily reach targets for anemia management and have continuous ultrafiltration allowing for the maintenance of good volume status, all of which will reduce risk for CVD. All treatable risk factors should be treated early in the development of CKD and should continue through their time on dialysis and after transplantation.
Prichard
Sarah
S
Nephrology Division, Royal Victoria Hospital, McGill University Health Centre, Montreal, Canada. sarah.prichard@muhc.mcgill.ca
D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D002423:Cause of Death; D015314:Dialysis Solutions / Q000009:adverse effects* / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006711:Homocystine / Q000032:analysis / Q000378:metabolism; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications / Q000175:diagnosis; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D008297:Male; D018384:Oxidative Stress; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis
D015314:Dialysis Solutions; D006711:Homocystine