Peritoneal dialysis is a reasonable option in patients with cardiovascular disease .

Abstract

Peritoneal dialysis (PD) has been proposed as a therapeutic option for patients with end-stage renal disease (ESRD) and cardiovascular (CV) disease. The study presented here aimed to compare incident PD patients with and without CV disease at baseline, in order to determine the impact of CV disease in the outcomes of long-term PD patients. This is a prospective cohort study performed at a single PD unit where 112 consecutive incident patients admitted to the PD program during 5years were studied. The background of CV disease at PD initiation was defined as: presence of coronary artery disease, cerebrovascular disease, heart failure, or peripheral arterial disease. Laboratory measurements as well as PD adequacy were obtained at the beginning of PD and at the last evaluation. The outcomes examined were patient and technique survival, hospitalization and peritonitis rate. Prevalence of diabetes was higher in patients with CV disease (53.3% vs. 31.7%, p=0.036). Patients who suffered from CV disease were, on average, older (62.8±13.1 vs. 49.7±15.7 years, p<0.05). There were no significant differences in other demographic or clinical variables, including hospital admissions (0.99 vs. 0.72 episodes/patient-year, p=0.057) or peritonitis rates (0.69 vs. 0.61 episodes/patient-year, p=0.652). The overall rates of PD technique failure were similar between both groups (CV disease patients: 12.7 transfers to hemodialysis (HD)/100 patient-years vs. 13.7 transfers to HD/100 patient-year; p=0.54). Diabetes and age were independently associated with the presence of CV disease (p=0.011), in a model adjusted for time on PD. The mortality rate was higher in CV disease patients (14.9 vs. 0.8 deaths/100 patient-years, p=0.000) and 75% of all-cause mortality occurred in diabetic patients. In a multivariate analysis, diabetes (hazard ratio (HR): 5.5, confidence interval (CI): 0.84-36.29, p=0.049) and age (HR: 1.07, CI: 1.0-1.13, p=0.047) were independent predictors of death in a model adjusted for residual diuresis, body mass index, and time on PD. This study compared incident PD patients with and without CV disease. CV disease patients were older but clinical and laboratorial targets, peritonitis rates, hospitalizations, and technique survival were similar between both groups, suggesting PD as an effective therapy for patients with CV comorbidities. .