China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis

Fanfan Hou,Fei Xiong,Xusheng Liu,Yixiang Zhang,Di Xie,Jianghua Chen,Pingyan Chen,Yan Yu,Xiao Yang,Wei Zhou,Xin Xu,Yanmin Zhang,Wei Shi,Shengjie Wu,Xinling Liang,Zhimin Zhang,Ping Zhang,Jianping Jiang,Changlin Mei,Xueqing Yu,Jun Li ,Qian Lin ,Shan Sun ,Quan Zhou

doi:10.1186/1471-2369-13-94

Abstract

BackgroundCardiovascular 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).MethodThe 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.ResultA 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.ConclusionsCardiovascular 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.

Highlights

Cardiovascular disease (CVD) is the main cause of death in patients on chronic dialysis
Cardiovascular morbidity during chronic dialysis was more prevalent in peritoneal dialysis (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

Summary

Introduction

Cardiovascular disease (CVD) is the main cause of death in patients on chronic dialysis. Cardiovascular disease (CVD) is the leading cause of death among patients undergoing maintenance dialysis. Compared with the general population, dialysis patients have a 10 to 20 times greater incidence of cardiovascular death [1,2,3,4]. Difference in the burden of cardiovascular morbidity in dialysis patients among selected countries has been described previously [5]. The prevalence of coronary artery disease in Asian dialysis population seems relatively lower than that in patients from western countries [5,6,7]. The reason for the difference has not been clarified but may correlate to the background cardiovascular morbidity in their respective general population [8], as well as the baseline characteristics of the dialysis population

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