Abstract
BackgroundPatients on peritoneal and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. The atherosclerosis is associated with increased arterial stiffness, endothelial dysfunction and elevated oxidative stress and inflammation. The aims of this study are to investigate the effects of peritoneal and hemodialysis on arterial stiffness, vascular function, myocardial structure and function, oxidative stress and inflammation in incident patients with end stage kidney disease.MethodsThis is an observational study. Eighty stage five CKD patients will be enrolled and followed for one-year. Primary outcome measures will be changes in 1) arterial stiffness measured by aortic pulse wave velocity, 2) oxidative stress assessed by plasma F2 isoprostanes and 3) inflammation measured by plasma pentraxin-3. Secondary outcomes will include additional measures of oxidative stress and inflammation, changes in vascular function assessed using the brachial artery reactivity technique, carotid artery intimal medial thickness, augmentation index and trans thoracic echocardiography to assess left ventricular geometry, and systolic and diastolic function. Patients will undergo these measures at baseline (6–8 weeks prior to starting dialysis therapy), then at six and 12 months after starting dialysis.DiscussionThe results of this study may guide the choice of dialysis modality in the first year of treatment. It may also lead to a larger study prospectively assessing the effect of dialysis modality on cardiovascular morbidity and mortality.Trial RegistrationACTRN12609000049279
Highlights
Patients on peritoneal and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality
End stage kidney disease (ESKD) patients undergoing dialysis have a substantially increased risk of cardiovascular morbidity and mortality[1] In 2007, 2311 new patients started dialysis in Australia and New Zealand but, many of these patients will die of cardiovascular disease. (ANZDATA 2007) The decision to undergo either peritoneal or haemodialysis is based on a number of factors
Comparing the effects of dialysis modalities on surrogate cardiovascular markers over time will provide unique important information to assist in the treatment of patients with ESKD
Summary
Patients on peritoneal and hemodialysis have accelerated atherosclerosis associated with an increase in cardiovascular morbidity and mortality. The atherosclerosis is associated with increased arterial stiffness, endothelial dysfunction and elevated oxidative stress and inflammation. The aims of this study are to investigate the effects of peritoneal and hemodialysis on arterial stiffness, vascular function, myocardial structure and function, oxidative stress and inflammation in incident patients with end stage kidney disease. Vascular and myocardial dysfunction are prominent, increasing the likelihood of cardiovascular disease morbidity and mortality in dialysis patients [4]. A number of studies have documented that peritoneal dialysis is associated with decreased levels of oxidative stress and inflammatory markers compared to haemodialysis [5]. No study has compared the changes in these markers over time in incident dialysis patients
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