Risk Factors for Cardiovascular Disease in Patients Undergoing Peritoneal Dialysis

Patients on peritoneal dialysis (PD) are at high cardiovascular risk. Although some risk factors are unmodifiable (for example, age, sex, genetics), others are exacerbated in the unfriendly uremic milieu (inflammation, oxidative stress, mineral disturbances) or contribute per se to kidney disease and cardiovascular progression (diabetes mellitus, hypertension). Moreover, several factors associated with PD therapy may both increase (by altered lipid profile, hyperinsulinemia, and formation of advanced glycation end-products) and decrease (by better blood pressure control and anemia management) cardiovascular risk. The present review discusses recent findings and therapy trends in cardiovascular research on the PD population, with emphasis on the roles of inflammation, insulin resistance, homocysteinemia, dyslipidemia, vascular calcification, and genetics/epigenetics.

Impact of peritoneal dialysis treatment on arterial stiffness and vascular changes in diabetic type 2 and nondiabetic patients with end-stage renal disease

Diabetes mellitus (DM) is the leading cause of the end-stage renal disease (ESRD). Vascular diseases are the most common cause of morbidity and mortality in the chronic kidney disease. The aim of this study was to analyze the impact of peritoneal dialysis (PD) treatment on morphologic and hemodynamic vascular parameters of carotid arteries in diabetic type 2 and nondiabetic patients with ESRD during the period of one year after the start of PD treatment using ultrasonography of carotid arteries and their relation on uremia and PD inherent factors. Mean intima-media thickness, plaque score, peak systolic velocity, end-diastolic velocity, and carotid diameter significantly decreased 12 months after PD treatment start in both groups. Significant reduction in median serum endothelin-1 concentration after 12 months on PD treatment was observed in the group of patients with DM (7.6–5.9 pg/mL) and also in group of patients without DM (3.6–3.3 pg/mL). Also median nitric oxide concentration significantly increased after 12 months on PD compared to baseline levels both in patients with DM (25.0–34.3 μmol/L) as was observed in patients without DM (49.6–56.5 μmol/L). PD treatment, with the regulation of these vasoactive molecules and other vascular risk factors, significantly contributes to vascular remodeling, especially in DM patients.

Applying Translational Research in Understanding Complications and Defining Targets for Intervention: Inflammation in PD as a Model

The bench-to-bedside approach to translational research is becoming increasingly important to efficiently advance understanding of the mechanisms underlying disease and to improve the quality of patient care. Although this investigation model has been practiced since the early days of the therapy, robust research platforms built to practice translational research have only recently been structured in the field of peritoneal dialysis. Experience with a translational research environment that generated most of the information cited in this overview is the core of this manuscript. The central investigation theme described is how to approach the cardiovascular complications of peritoneal dialysis. The research question was, could the continuous activation of inflammatory pathways be central in this process and represent a relevant target for interventions?