ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I – Assessment and Management of Various Cardiovascular Risk Factors

Wang, Angela Yee-Moon; Brimble, K. Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W.; Kang, Shin Wook; Kooman, Jeroen P.; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits‐Filho, Roberto

doi:10.3747/pdi.2014.00279

Cited by 128 publications

(129 citation statements)

References 53 publications

(55 reference statements)

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“…The appropriate salt intake is the first treatment option for proper maintenance of the volume state [93]. The recommendation according to the Cardiovascular and Metabolic Guidelines of the International Society for Peritoneal Dialysis is to reduce intake to <2 g of sodium or <5 g of salt per day [94]. The lack of adherence to these recommendations is an important cause of fluid gain in patients undergoing PD [95].…”

Section: Salt Restriction and Volume Statusmentioning

confidence: 99%

Fluid Overload in Peritoneal Dialysis

Pazarín-Villaseñor¹,

Yanowsky-Escatell²,

Andrade‐Sierra³

et al. 2018

Chronic Kidney Disease - From Pathophysiology to Clinical Improvements

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The prevalence of end-stage renal disease (ESRD) has increased globally to 10% due to diabetes mellitus, hypertension, and stroke. When chronic kidney disease (CKD) maintenance therapy fails, patients require renal replacement therapy (RRT) to survive, such as peritoneal dialysis (PD), hemodialysis, and renal transplantation. The most common therapy in Mexico is PD because it is a feasible, low-cost, and easy-to-perform procedure; however, fluid overload is a frequent condition in patients with this RRT modality.The usual adverse comorbidities in patients with PD are cardiovascular diseases (CVD) associated to atherosclerosis, uremia, inflammation, and oxidative stress. Fluid overload is intimately associated to hypertension, left ventricular hypertrophy, heart failure, and worsening of kidney failure, leading to increased hospital admissions, higher cardiovascular mortality, and reduced life expectancy. Two main pathologies are involved in the deterioration of both heart and kidney functions, namely, cardiorenal syndrome and uremic cardiomyopathy. Along with these phenomena, patients in PD with rapid peritoneal transport have reduced ultrafiltration, increased glucose absorption, and albumin loss in the dialysate, which lead to overhydration, hypertension, dyslipidemia, and malnutrition. This review focuses on the clinical, physiological, and biochemical mechanisms involved in fluid overload of patients with CKD undergoing PD.

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Section: Salt Restriction and Volume Statusmentioning

confidence: 99%

Fluid Overload in Peritoneal Dialysis

Pazarín-Villaseñor¹,

Yanowsky-Escatell²,

Andrade‐Sierra³

et al. 2018

Chronic Kidney Disease - From Pathophysiology to Clinical Improvements

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“…More recently, the International Society for Peritoneal Dialysis (ISPD) Cardiovascular Guidelines suggest "individualization of warfarin prescription for prevention of stroke in peritoneal dialysis patients with atrial fibrillation in view of an increased risk of bleeding and uncertain effects on cerebrovascular outcomes. (2D)" (35,36).…”

Section: Uncertainty Of Warfarin Net Benefitmentioning

confidence: 99%

Anticoagulation for Atrial Fibrillation in End-stage Kidney Disease

Lee¹,

Johnson²

2015

jcbmr

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Atrial fibrillation (AF) is the most common arrhythmia in the general population and it has been found to have a higher prevalence in end-stage kidney disease (ESKD). It is associated with a higher risk of stroke and mortality compared to those without AF. Patients with ESKD have generally been excluded from randomized controlled trials (RCTs) evaluating the efficacy of anticoagulation in reduction of stroke risk. Current observational evidence for anticoagulation for AF in the ESKD population has yielded conflicting results, but in aggregate favours a lack of benefit in stroke risk reduction with an increase in bleeding risk. There are also reports that warfarin use in ESKD patients on dialysis is associated with greater International Normalised Ratio (INR) variability and increased risk of vascular calcification and calciphylaxis (uraemic calcific arteriolopathy). RCTs are required to assess the net clinical benefit of anticoagulation in this group.

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“…The results suggested that glucose-sparing PD regimens may improve surrogate metabolic outcomes, albeit possibly at the expense of optimal peritoneal ultrafiltration and fluid control. The ISPD Guidelines recommend that "once daily icodextrin be considered as the long-dwell dialysis solution in diabetic peritoneal dialysis patients for better glycaemic control" [71].…”

Section: Diabetesmentioning

confidence: 99%

“…Furthermore, the KDOQI guidelines advise clinicians that dosing of insulin and oral hypoglycaemic agents may change markedly as patients transition onto dialysis-often with increased requirements in PD [20]. The ISPD Guidelines recommend an HbA1c target of 7% (53 mmol/mol) in PD patients with diabetes, which may be increased up to 8.5% (69 mmol/mol) in older patients [71].…”

Section: Diabetesmentioning

confidence: 99%

Cardiovascular Disease in Dialysis Patients

Jegatheesan¹,

Yang²,

Krishnasamy³

et al. 2018

Aspects in Dialysis

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Cardiovascular disease (CVD) is highly prevalent in the dialysis population, affecting up to 60% of cohorts. Cardiovascular mortality rates are reported to be ~14 per 100 patient-years, which are 10-to 20-fold greater than those of age-and gender-matched controls. CVD is the primary cause of death in up to 40% of dialysis patients in Australia, New Zealand and the United States. Dialysis patients endure a greater burden of both traditional risk factors for CVD and risk factors related to loss of kidney function that may account for the higher CVD morbidity and mortality. Many cardiology guidelines include chronic kidney disease (CKD) and end-stage kidney disease (ESKD) as coronary heart disease (CHD) risk equivalents. It is therefore important for clinicians to both recognise and optimise the cardiovascular health of patients receiving maintenance dialysis. This chapter will focus on risk factor modification, screening and prevention of CVD in dialysis patients.

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ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I – Assessment and Management of Various Cardiovascular Risk Factors

Cited by 128 publications

References 53 publications

Fluid Overload in Peritoneal Dialysis

Fluid Overload in Peritoneal Dialysis

Anticoagulation for Atrial Fibrillation in End-stage Kidney Disease

Cardiovascular Disease in Dialysis Patients

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