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. 2015 Feb;5(1):20-30.
doi: 10.1159/000369588. Epub 2014 Dec 13.

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

Silvia Lai  1 , Alessio Molfino  1 , Gaspare Elios Russo  2 , Massimo Testorio  2 , Alessandro Galani  1 , Georgie Innico  2 , Nicla Frassetti  1 , Valentina Pistolesi  3 , Santo Morabito  3 , Filippo Rossi Fanelli  1
Affiliations

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

Silvia Lai et al. Cardiorenal Med. 2015 Feb.

Abstract

Introduction: Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients.

Materials and methods: 45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH) and arterial blood gas analysis were also evaluated.

Results: LVMI was higher in PD than HD patients (139 ŷ 19 vs. 104 ŷ 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined.

Conclusions: Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored.

Keywords: Blood pressure; Cardiothoracic ratio; Chronic kidney disease; Inflammation; Left ventricular hypertrophy; Mineral metabolism.

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Figures

Fig. 1
Fig. 1
Box-and-whisker plots. a SBP in PD patients versus HD patients. b DBP in PD patients versus HD patients. c Median arterial BP (MAP) in PD patients versus HD patients. • = Outliers.
Fig. 2
Fig. 2
Bar charts with error bars. The mean value of LVMI was significantly higher in PD patients compared with HD patients (* p = 0.037). Boxes represent means; error bars indicate ŷ2 SD.
Fig. 3
Fig. 3
Linear regression plot. LVMI versus iPTH in PD patients (r = 0.704, p = 0.041).
Fig. 4
Fig. 4
Linear regression plot. LVMI versus CRP in PD patients (r = 0.701, p = 0.032).
See this image and copyright information in PMC

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