Peritoneal dialysis and cardiovascular disease.

Cardiovascular (CV) death is the most frequent cause of dying in peritoneal dialysis (PD) patients. Risk factors include not only those that can be present in the general population, but also those related to the presence of end-stage renal disease (ESRD) and factors that are specific for PD modality. Hypertension is the most important general risk factor in PD patients, while obesity remains controversial. Inflammation, malnutrition, calcifications and probably endothelial dysfunction and oxidative stress are all CV risk factors present in ESRD that contribute to mortality in PD patients. Additional CV risk factors in PD are related to the glucose load, leading to increasing insulin resistance and a more atherogenic lipid profile. The presence of glucose degradation products in conventional dialysis solutions is mainly related to the development of peritoneal abnormalities, but not directly to cardiovascular disease. Loss of residual renal function and ultrafiltration failure promote overhydration, which is the most important PD-related risk factor for CV disease.

Five-year survival in comparable HD and PD patients: one center's experience.

Several studies have yielded conflicting results regarding morbidity and mortality in peritoneal dialysis (PD) and hemodialysis (HD) patients. We performed a retrospective analysis in end-stage renal disease (ESRD) patients in our department, who were equally distributed between HD and PD, in order to compare 5-year survival probabilities and hospitalization rates in the two modalities. Of the total 94 new ESRD patients who initiated dialysis in our department from January 1995 to December 2000, 48 were allocated to PD and 46 to HD. All patients were followed up for five years. There were no significant differences regarding demographics and serious co-morbidities upon dialysis initiation between HD and PD patients. Unadjusted 5-year survival probability in as-treated analysis was higher in PD patients (0.79 vs 0.6, p=0.04), whereas there was no significant difference in intent-to-treat analysis between HD and PD patients (p=0.5). Hospitalization rates were similar in both modalities. Despite the small number of patients included in our study, it seems that when HD and PD are both available in one department they have equivalent results regarding morbidity and mortality rates. Therefore we suggest that, when possible, PD and HD should be equally offered to all ESRD patients.

Individual renal function in polycystic kidney disease: a follow-up study.

PURPOSE: This study was undertaken to determine individual renal function in patients with autosomal dominant polycystic kidney disease (ADPKD). MATERIALS AND METHODS: The authors initially examined (study t1) 25 patients with ADPKD (12 female, 13 male; ages 18 to 68 years). The serum creatinine concentration and glomerular filtration rate, measured by Tc-99m DTPA, were 1.5 +/- 0.56 mg/dl and 65.7 +/- 31 ml.minute-1.1.73 m2, respectively. Thirteen patients had a follow-up study (t2) 2 years after their initial evaluations. Individual renal function was assessed on Tc-99m DMSA renal scans. RESULTS: The mean (+/- SD) difference between left kidney DMSA (DMSA-L) and right kidney DMSA (DMSA-R) was 7.04 % +/- 16.48%. In 20 patients (80%), the left kidney had a lower percentage contribution to the total renal function compared with the right kidney. When the results of the two studies were compared, deterioration in renal function was noted. In the t1 study, the mean serum creatinine concentration and glomerular filtration rate were 1.7 mg/dl and 67.02 ml.minute-1.1.73 m2 respectively, and in the t2 study these values were 2.01 mg/dl and 57.15 ml.minute-1.1.73 m2, respectively. No difference, however, was found in individual renal function in the two studies. CONCLUSIONS: In patients with ADPKD, the percentage contribution of each kidney to total renal function is not equal and remains stable during the progression of renal failure.