Increased peritoneal permeability at peritoneal dialysis initiation is a potential cardiovascular risk in patients using biocompatible peritoneal dialysis solution.

Yoshifumi Hamasaki,Eisei Noiri,Masaomi Nangaku,Yukio Homma,Kent Doi,Toshiro Fujita,Haruki Kume,Yoshitaka Ishibashi,Yutaka Enomoto,Mototsugu Tanaka

doi:10.1186/1471-2369-15-173

Abstract

BackgroundCardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Biocompatible peritoneal dialysis solutions with neutral pH have been anticipated to reduce cardiovascular disease more than conventional peritoneal dialysis solutions with low pH, but it remains unclear which factors at peritoneal dialysis initiation increase cardiovascular risk in patients using biocompatible peritoneal dialysis solutions. This study was undertaken to investigate which clinical factors at peritoneal dialysis initiation, including peritoneal transport status, are associated with cardiovascular event in patients using biocompatible peritoneal dialysis solution.MethodsThis retrospective cohort study of peritoneal dialysis patients using biocompatible solutions with neutral pH assessed relations of clinical parameters at peritoneal dialysis initiation to cardiovascular event during the subsequent five years.ResultsOf 102 patients who started peritoneal dialysis, cardiovascular event occurred in 18. Age, history of cardiovascular disease before peritoneal dialysis initiation, hemoglobin, serum albumin, C-reactive protein, peritoneal permeability defined by the ratio of dialysate to plasma creatinine concentration at 4 hr (D/Pcre) in peritoneal equilibration test (PET), number of patients in each PET category defined by D/Pcre, and peritoneal protein clearance significantly differed between patients with and without cardiovascular event. For patients divided according to PET category using Kaplan–Meier method, the group of high average to high peritoneal transporters exhibited significantly high incidence of cardiovascular event and mortality compared with the groups of low and low-average peritoneal transporters (Log rank; p = 0.0003 and 0.005, respectively). A Cox proportional hazards model showed independent association of PET category classification with cardiovascular event.ConclusionsPeritoneal permeability expressed as PET category at peritoneal dialysis initiation is an independent cardiovascular risk factor in peritoneal dialysis patients using biocompatible peritoneal dialysis solution with neutral pH. Greater peritoneal permeability at peritoneal dialysis initiation might reflect subclinical vascular disorders.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2369-15-173) contains supplementary material, which is available to authorized users.

Highlights

Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients
Peritoneal permeability expressed as peritoneal equilibration test (PET) category at peritoneal dialysis initiation is an independent cardiovascular risk factor in peritoneal dialysis patients using biocompatible peritoneal dialysis solution with neutral pH
This study demonstrated that peritoneal small solute permeability, expressed as PET category classification defined by D/Pcre, was independently associated with a CV event within five years after peritoneal dialysis (PD) initiation in patients using biocompatible PD solutions (BPDSs)

Summary

Introduction

Cardiovascular disease is a frequent cause of death in peritoneal dialysis patients. Cardiovascular disease (CVD) is the most common cause of death in end-stage renal disease (ESRD) patients. It is noteworthy that CVD causes high mortality and disabilities, which make it difficult for patients to continue peritoneal dialysis (PD) therapy by themselves. Physical disability caused by CVD affects the selection of dialysis modality, which is one of the possible reasons for the lack of increase of PD patients [2]. Several non-traditional cardiovascular risk factors specific for PD therapy are known, such as decreased residual renal function, ultrafiltration failure, and peritoneal protein loss [3,4,5]

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