Abstract
Cardiovascular disease accounts over half of the total mortality in peritoneal dialysis (PD) patients. In addition, there is an increasing recognition of a high prevalence of vascular and valvular calcification that may contribute to the increased all-cause and cardiovascular mortality in the PD patients. Disturbed mineral metabolism in association with chronic kidney disease has been suggested as one of the major contributing factors to the increased vascular/valvular calcification in this population. In this paper, we provide an overview of the prevalence and importance of this complication in the PD patients. In addition, we review the contributing factors and some emerging mechanisms for this complication. Furthermore, we discuss some therapeutic strategies that may be useful in limiting the progression of vascular/valvular calcification in the PD population.
Highlights
Cardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) patients receiving long-term peritoneal dialysis (PD) therapy
Data from the Canada and United States (CANUSA) Peritoneal Dialysis Study showed that nearly half of the mortality in PD patients was due to cardiovascular disease [1]
Previous longitudinal study showed a significant association between serum phosphorus and calcium × phosphorus product with changes in coronary artery calcification over 1 year in PD patients [37], providing further evidence to support the involvement of hyperphosphatemia in vascular/valvular calcification in PD patients
Summary
Cardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) patients receiving long-term peritoneal dialysis (PD) therapy. Vascular/valvular calcifications are important and highly prevalent complications in ESRD patients including those receiving PD therapy and very much contributed to the exceedingly high cardiovascular mortality in this population. Cardiac valvular calcification, detected using echocardiography, predicts all-cause mortality and cardiovascular death in chronic PD patients Patients with both aortic and mitral valvular calcification showed the highest risk of mortality and cardiovascular death compared to those with either heart valve calcification or no valve calcification [6]. These data suggest that the presence of vascular or valvular calcification, irrespective of the sites involved, is indicative of a poor prognosis in the dialysis population including patients on PD. We discussed therapeutic strategies that may be useful in retarding calcification burden in the PD patients
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