Comparison of cardiovascular mortality in hemodialysis versus peritoneal dialysis

Ng, Cheng Han; Ong, Zhi Hao; Sran, Hersharan Kaur; Wee, Teo Boon

doi:10.1007/s11255-020-02683-9

Cited by 21 publications

(15 citation statements)

References 60 publications

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“…The physiology of HD and PD are fundamentally different, and past observational studies have shown differences in mortality and morbidity between the two dialysis modalities. [35][36][37][38][39] The risk of SCD is approximately 1.5-fold higher in patients undergoing HD compared with those undergoing PD within the first 3 months after starting dialysis, although this discrepancy in risk diminishes after 2 years of dialysis. 40 Our present study followed patients for a mean of 2.54 years in the MRA group and 2.12 years in the non-MRA group, during which the risk of SCD may be higher among those .…”

Section: Discussionmentioning

confidence: 99%

The effects of mineralocorticoid receptor antagonists on cardiovascular outcomes in patients with end‐stage renal disease and heart failure

Lin

et al. 2022

European J of Heart Fail

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Aims Mineralocorticoid receptor antagonists (MRAs) have been shown to provide survival benefits in patients with heart failure; however, MRA use in patients with chronic kidney disease has been limited by safety concerns. The effects of MRAs on outcomes in patients with end‐stage renal disease (ESRD) and heart failure remain unknown. The aim of this study was to evaluate the effects of MRAs on cardiovascular outcomes in patients with heart failure under maintenance dialysis in a real‐world setting. Methods and results A retrospective cohort study was conducted by collecting data from the Taiwan National Health Insurance Research Database (NHIRD). Patients diagnosed with heart failure and ESRD and who started maintenance dialysis between 1 January 2001 and 31 December 2013 were identified. Patients were grouped according to MRA prescription. The outcomes of interest included cardiovascular (CV) death, hospitalization for heart failure (HHF), all‐cause mortality, acute myocardial infarction (AMI), ischaemic stroke, any coronary revascularization procedures, and new‐onset hyperkalaemia. Propensity score matching was performed at a 1:3 ratio between MRA users and non‐users to minimize selection bias. A total of 50 872 patients who satisfied our inclusion and exclusion criteria were identified. After 1:3 matching, 2176 patients were included in the MRA group, and 6528 patients were included in the non‐MRA group. The risk of CV death was significantly lower among patients who received MRAs than those who did not (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.80–0.95), as was the risk of all‐cause mortality (HR 0.88, 95% CI 0.83–0.94). Reductions in the risks of CV death and all‐cause mortality were more prominent among patients undergoing haemodialysis and those with coronary artery disease. Conclusions In patients undergoing regular dialysis who are diagnosed with heart failure, the use of MRAs is associated with lower risks of all‐cause mortality and CV death. The benefits of MRA treatment in heart failure may persist in patients with ESRD. Further investigations through randomized controlled trials are needed to assess the efficacy and safety of MRAs in this high‐risk population.

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Section: Discussionmentioning

confidence: 99%

The effects of mineralocorticoid receptor antagonists on cardiovascular outcomes in patients with end‐stage renal disease and heart failure

Lin

et al. 2022

European J of Heart Fail

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“…It is the first randomized controlled trial that evaluated the cardiac ANS effects of a long-term, home-based combined exercise program in DKD patients undergoing maintenance HD. These results are noteworthy, as cardiovascular disease is responsible for approximately 40% of deaths in ESKD patients [ 51 ], and the prevalence of DM-2, according to global estimations, will increase by 3% to 6% at the end of 2025, with approximately 3 million patients with DM-2 [ 52 ]. On the other hand, a limitation of this study is its small sample size, mainly due to the difficulties of recruiting patients for long-term exercise training studies.…”

Section: Discussionmentioning

confidence: 99%

Effects of Home-Based Exercise Training on Cardiac Autonomic Neuropathy and Metabolic Profile in Diabetic Hemodialysis Patients

Michou

Liakopoulos

Roumeliotis

et al. 2023

Life

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Background: This study aimed to investigate the effects of a home-based exercise training program on Cardiac Autonomic Neuropathy (CAN) and metabolic profile in Diabetic Kidney Disease (DKD) patients undergoing maintenance hemodialysis (HD). Method: Twenty-eight DKD patients undergoing hemodialysis were randomly assigned into two groups. The exercise (EX) group followed a 6-month combined exercise training program at home, while the control (CO) group remained untrained. All participants at baseline and the end of the study underwent cardiopulmonary exercise testing (CPET), biochemical tests for glucose and lipid profile, and 24-h electrocardiographic monitoring for heart rate variability (HRV) analysis and heart rate turbulence (HRT). Results: At the end of the study, compared to the CO, the EX group showed a significant increase in serum high-density lipoprotein (HDL) by 27.7% (p = 0.01), peak oxygen uptake (VO2peak) by 9.3% (p < 0.05), the standard deviation of R-R intervals (SDNN) by 34.3% (p = 0.03), percentage of successive RR intervals higher than 50ms (pNN50) by 51.1% (p = 0.02), turbulence slope (TS) index by 18.4% (p = 0.01), and decrease in (glycated hemoglobin) HbA1c by 12.5% (p = 0.04) and low-frequency power LF (ms2) by 29.7% (p = 0.01). Linear regression analysis after training showed that VO2peak was correlated with SDNN (r = 0.55, p = 0.03) and HF (r = 0.72, p = 0.02). Multiple regression analysis indicated that the improvement of sympathovagal balance and aerobic capacity depended on patients’ participation in exercise training. Conclusion: In conclusion, a 6-month home-based mixed-type exercise program can improve cardiac autonomic function and metabolic profile in DKD patients on HD.

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“…Patients with chronic kidney disease treated by dialysis have an increased risk of mortality, in particular cardiovascular mortality [1]. Increasing the amount of dialysis to achieve greater urea clearance has not been shown to improve patient survival [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Is the measurement of tissue advanced glycosylation products by skin autofluorescence associated with mortality in patients treated by peritoneal dialysis?

2022

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Background Advanced glycosylated end-products (AGEs) have been shown to cause cardiovascular disease, and tissue AGE accumulation can be measured by skin autofluorescence (SAF). AGEs are cleared by the kidney, and thus accumulate in dialysis patients. However, as the results of SAF measurements in peritoneal dialysis patients (PD) have been ambiguous, we examined the association between mortality and SAF. Methods We reviewed SAF measurements in PD patients attending a university associated PD program, along with standard measurements of dialysis adequacy and peritoneal membrane function. Results We studied 341 prevalent PD patients, 61.9% male, mean age 61.2 ± 16 years, and 31.4% of all patients died during a median follow-up of 27.2 (23.3–36.3) months. Patients who died were older, mean age 72 ± 10.5 years, were more often diabetic (60.7%), and had higher median SAF 3.8 (3.2–4.5) AU. On logistic regression, mortality was independently associated with age (odds ratio (OR) 1.1 (95% confidence limits 1.06–1.16), diabetes OR 10.1 (3.1–33.4), SAF OR 3.3 (1.8–6.2), all p < 0.001, and male gender OR 5.2 (1.6–17.4), p = 0.007; and negatively associated with weight OR 0.91 (0.86–0.95), p < 0..001, normalised nitrogen appearance rate (nPNA) OR 0.05 (0.01–0.4), p = 0.005 and mean arterial blood pressure (MAP) OR 0.96 (0.93–0.96), p = 0.03. Conclusions In this observational study, SAF was independently associated with mortality. However, other factors were also associated with mortality, including age, diabetes and malnutrition which have all been reported to affect SAF measurements. Thus, the additional predictive value of measuring SAF compared to standard risk factors for mortality remains to be determined. Graphical abstract

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Comparison of cardiovascular mortality in hemodialysis versus peritoneal dialysis

Cited by 21 publications

References 60 publications

The effects of mineralocorticoid receptor antagonists on cardiovascular outcomes in patients with end‐stage renal disease and heart failure

The effects of mineralocorticoid receptor antagonists on cardiovascular outcomes in patients with end‐stage renal disease and heart failure

Effects of Home-Based Exercise Training on Cardiac Autonomic Neuropathy and Metabolic Profile in Diabetic Hemodialysis Patients

Is the measurement of tissue advanced glycosylation products by skin autofluorescence associated with mortality in patients treated by peritoneal dialysis?

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