Potential Risk Factors for Cardiovascular Events in Incident Peritoneal Dialysis Patients

Abstract

BACKGROUND: Cardiovascular (CV) events are among the major causes of mortality and morbidity in dialysis patients. The purpose of this study was to investigate the potential risk factors of CV complications in incident peritoneal dialysis (PD) patients with no underlying coronary artery disease or congestive heart failure before PD.METHODS: The study was performed retrospectively in a hospital-facilitated PD center. A total of 122 adult patients without a known history of coronary heart disease or heart failure were enrolled from January 2005 to December 2008, with an observation period of 3 years. The mean age of the subjects was 55.2 years, and the men-to-women ratio was 53:69. The analyzed variables included biochemical profiles, peritoneal transport rate, cardiothoracic ratio in chest radiography, Kt/V urea, and weekly creatinine clearance indices at baseline and 3 years after PD initiation. The records of prescription with renin-angiotensin-system blockade drugs, glucose-free PD solution dwell, and total glucose exposure were also included in the analysis. Primary outcomes were defined as CV events recorded in the emergency department, in the outpatient clinic, and on hospital admissions.RESULTS: Twenty-two patients had CV events during the study period. There were statistically significant differences in diabetes, hypertension, fasting blood sugar level, and glucose-free PD solution dwell between subjects with and without CV events. Multivariate analysis revealed that higher baseline fasting sugar (≥126 mg/dL) (HR, 3.7; 95% CI, 1.2-11.4) and glucose-free PD solution dwell (HR, 7.3; 95% CI, 1.380-135.8) were risk factors for CV events in incident PD patients.CONCLUSION: The study showed that baseline serum glucose level and glucose-free PD solution dwell were potential risk factors predicting CV events after PD initiation. The results indicated the essential role of sugar and fluid control in PD patients.