Cardiovascular disease in peritoneal dialysis: A review

Cardiovascular disease (CVD) continues to account for a very high percentage of deaths in patients with ESRD. An entire gamut of risks factors-some well known, some still being understood and yet more putative are operational in patients with renal disease. CVD assumes enhanced importance in the wake of its disproportionate effect on patients with uremia. Some studies have reported an upto 15 fold higher cardiovascular death rate in patients on PD when compared to non-uremic cohorts. Thus it follows that the longevity of patients on PD is directly related to improvements in the recognition, management and prevention of CVD. While the conventional risk factors like age/diabetes/hypertension/hyperlipidemia/smoking etc need no elaboration, factors unique to renal failure like calcium/phosphorus/Vitamin D abnormalities, anemia, dialysis related chronic inflammation etc add to the burden and pathogenesis of CVD. Specific to PD, certain abnormalities like hypoalbuminemia and attendant malnutrition, metabolic abnormalities and even high transporter status (speculative) are thought to propagate the progression of CVD. A review of CVD in PD is incomplete without a referral to non-atherosclerotic disease-volume overload, congestive heart failure and LVH. This review looks into the spectrum of CVD in PD patients, its pathogenesis, and factors unique to PD, and possible therapeutic and preventative measures.