title: China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is the main cause of death in patients on chronic dialysis. The question whether dialysis modality impacts cardiovascular risk remains to be addressed. China Collaborative Study on Dialysis, a multi-centers cohort study, was performed to evaluate cardiovascular morbidity during maintenance hemodialysis (HD) and peritoneal dialysis (PD).
  
  
  METHODS
  The cohort consisted of chronic dialysis patients from the database of 9 of the largest dialysis facilities around China. The inclusion period was between January 1, 2005, and December 1, 2010. Cardiovascular morbidity was defined as the presence of clinically diagnosed ischemic heart disease, heart failure, peripheral vascular disease, and/or stroke. The patients who had cardiovascular morbidity before initiation of dialysis were excluded. Data collection was based on review of medical record.
  
  
  RESULTS
  A total of 2,388 adult patients (1,775 on HD and 613 on PD) were enrolled. Cardiovascular morbidity affected 57% patients and was comparable between HD and PD patients. However, clinically diagnosed ischemic heart disease and stroke was more prevalent in PD than HD patients. When the patients were stratified by age or dialysis vintage, the cardiovascular morbidity was significantly higher in PD than HD among those aged 50 years or older, or those receiving dialysis over 36 months. Multivariate analysis revealed that the risk factors for cardiovascular morbidity had different pattern in PD and HD patients. Hyperglycemia was the strongest risk factor for cardiovascular morbidity in PD, but not in HD patients. Hypertriglyceridemia and hypoalbuminemia were independently associated with CVD only in PD patients.
  
  
  CONCLUSIONS
  Cardiovascular morbidity during chronic dialysis was more prevalent in PD than HD patients among those with old age and long-term dialysis. Metabolic disturbance-related risk factors were independently associated with CVD only in PD patients. Better understanding the impact of dialysis modality on CVD would be an important step for prevention and treatment.
authors.affiliation: Division of Nephrology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China. ffhouguangzhou@163.com
authors.forename: Fanfan
authors.initials: F
authors.lastname: Hou
authors.forename: Jianping
authors.initials: J
authors.lastname: Jiang
authors.forename: Jianghua
authors.initials: J
authors.lastname: Chen
authors.forename: Xueqing
authors.initials: X
authors.lastname: Yu
authors.forename: Qiugen
authors.initials: Q
authors.lastname: Zhou
authors.forename: Pingyan
authors.initials: P
authors.lastname: Chen
authors.forename: Changlin
authors.initials: C
authors.lastname: Mei
authors.forename: Fei
authors.initials: F
authors.lastname: Xiong
authors.forename: Wei
authors.initials: W
authors.lastname: Shi
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
authors.forename: Xusheng
authors.initials: X
authors.lastname: Liu
authors.forename: Shiren
authors.initials: S
authors.lastname: Sun
authors.forename: Di
authors.initials: D
authors.lastname: Xie
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Xiao
authors.initials: X
authors.lastname: Yang
authors.forename: Yixiang
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Zhang
authors.forename: Xinling
authors.initials: X
authors.lastname: Liang
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Zhang
authors.forename: Qizhan
authors.initials: Q
authors.lastname: Lin
authors.forename: Yan
authors.initials: Y
authors.lastname: Yu
authors.forename: Shengjie
authors.initials: S
authors.lastname: Wu
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control*; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000534:rehabilitation*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome