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

Hamasaki Y, Doi K, Tanaka M, Kume H, Ishibashi Y, Enomoto Y, Fujita T, Homma Y, Nangaku M, Noiri E - BMC Nephrol (2014)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan. noiri-tky@umin.ac.jp.

ABSTRACT

Background: Cardiovascular 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.

Methods: This 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.

Results: Of 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.

Conclusions: Peritoneal 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.

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Related in: MedlinePlus

Kaplan–Meier plots of incidence of CV event (A), survival rate (B), and technique survival rate (C) of PD patients using BPDS with neutral pH according to PET category. 102 patients were divided into three groups based on PET category defined by D/Pcre. Patients with D/Pcre <0.50 are in the low (L) group (n = 19), 0.50 ≤ D/Pcre <0.65 are in the low average (LA) group (n = 59), and D/Pcre ≥0.65 are in the high average and high (HA + H) group (n = 24).
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Fig1: Kaplan–Meier plots of incidence of CV event (A), survival rate (B), and technique survival rate (C) of PD patients using BPDS with neutral pH according to PET category. 102 patients were divided into three groups based on PET category defined by D/Pcre. Patients with D/Pcre <0.50 are in the low (L) group (n = 19), 0.50 ≤ D/Pcre <0.65 are in the low average (LA) group (n = 59), and D/Pcre ≥0.65 are in the high average and high (HA + H) group (n = 24).

Mentions: The incidence of CV event, survival rate, and technique survival rate were examined by comparing patients in the L, LA, and HA + H groups using the Kaplan–Meier method and the log-rank test (Figure 1). Patients in the HA + H group had worse CVD morbidity, survival rate, and technique survival rate than those in the L or LA group. Patients in the HA + H group had significantly lower levels of serum albumin and higher P-PrCl than those in the L or LA group (Table 4).Figure 1


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

Hamasaki Y, Doi K, Tanaka M, Kume H, Ishibashi Y, Enomoto Y, Fujita T, Homma Y, Nangaku M, Noiri E - BMC Nephrol (2014)

Kaplan–Meier plots of incidence of CV event (A), survival rate (B), and technique survival rate (C) of PD patients using BPDS with neutral pH according to PET category. 102 patients were divided into three groups based on PET category defined by D/Pcre. Patients with D/Pcre <0.50 are in the low (L) group (n = 19), 0.50 ≤ D/Pcre <0.65 are in the low average (LA) group (n = 59), and D/Pcre ≥0.65 are in the high average and high (HA + H) group (n = 24).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230909&req=5

Fig1: Kaplan–Meier plots of incidence of CV event (A), survival rate (B), and technique survival rate (C) of PD patients using BPDS with neutral pH according to PET category. 102 patients were divided into three groups based on PET category defined by D/Pcre. Patients with D/Pcre <0.50 are in the low (L) group (n = 19), 0.50 ≤ D/Pcre <0.65 are in the low average (LA) group (n = 59), and D/Pcre ≥0.65 are in the high average and high (HA + H) group (n = 24).
Mentions: The incidence of CV event, survival rate, and technique survival rate were examined by comparing patients in the L, LA, and HA + H groups using the Kaplan–Meier method and the log-rank test (Figure 1). Patients in the HA + H group had worse CVD morbidity, survival rate, and technique survival rate than those in the L or LA group. Patients in the HA + H group had significantly lower levels of serum albumin and higher P-PrCl than those in the L or LA group (Table 4).Figure 1

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Nephrology and Endocrinology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan. noiri-tky@umin.ac.jp.

ABSTRACT

Background: Cardiovascular 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.

Methods: This 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.

Results: Of 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.

Conclusions: Peritoneal 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.

Show MeSH
Related in: MedlinePlus