Peritoneal dialysis has optimal intradialytic hemodynamics and preserves residual renal function: Why isn't it better than hemodialysis?

Abstract

Rates of cardiovascular mortality are disproportionately high in patients with end stage kidney disease receiving dialysis. However, it is now generally accepted that patient survival is broadly equivalent between the two most frequently used forms of dialysis, in‐center hemodialysis (HD) and peritoneal dialysis (PD). This equivalent patient survival is notable when considering how specific aspects of HD have been shown to contribute to morbidity and mortality. These include more rapid loss of residual renal function (RRF), HD‐induced myocardial and cerebral ischemia, and risk factors associated with the intermittent delivery of HD. Potential mechanisms specific to PD that may drive cardiovascular disease include the metabolic consequences of excessive absorption of glucose and glucose degradation products (GDPs), inadequate volume control, and high rates of hypokalemia. The aim of this review is to compare and contrast the different drivers of adverse outcomes between the dialysis modalities, as greater understanding of this may help in patient‐centered decision‐making when considering options for renal replacement therapy.

Recurrent pulseless electrical activity and cardiac arrest caused by baroreceptor failure following neck irradiation

“…We hypothesise that this trigger resulted in disruption to the normal pattern of autonomic outflow with a subsequent cardio-inhibitory and vasodepressor response. That no further episodes were provoked by PD probably reflects the fewer haemodynamic changes associated with this modality over IHD 5 . Finally, while this report is a case of cardiovascular collapse in a dialysis unit, it may be deduced that relevant similar situations in the context of an emergency department could be large-volume abdominal paracentesis or pleural drainage.…”

Supine equilibration of extracellular fluid in peritoneal dialysis varies with intra-abdominal pressure

“…How these subtle pressure changes relate to filtration and reabsorption in the renal microcirculation remains to be studied, especially as maintenance of residual renal function is one of the main treatment goals in PD. 28,29…”

“…How these subtle pressure changes relate to filtration and reabsorption in the renal microcirculation remains to be studied, especially as maintenance of residual renal function is one of the main treatment goals in PD. 28,29 Changes in body position importantly affect the cardiovascular function and the body fluid distribution. 30 Assuming a supine body position the immediate gravity-induced changes in local hydrostatic pressures below or above the hydrostatic indifference region 31 are expected to lead to rapid cranial shifts of blood volume followed by a much slower fluid redistribution between intra-and extravascular spaces which may take up to 30-60 min.…”

Cardiovascular mortality in peritoneal dialysis: the impact of mineral disorders

“…Peritoneal dialysis (PD) is an important alternative for the treatment of patients with chronic kidney disease (CKD), with potential advantages from a clinical, logistical, and cost perspectives in relation to hemodialysis (HD) 1 . Cardiovascular disease accounts for approximately half of the cases of death and one third of the hospitalizations of these patients 2 .…”