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29th World Cardiology Conference

Edinburgh, Scotland

Daniela Lončar

University Clinical Center Tuzla, Bosnia and Herzegovina

Title: Risk of cardiovascular disease in dialysis patients

Biography

Biography: Daniela Lončar

Abstract

Introduction: Cardiovascular diseases are the greatest cause of morbidity and mortality in patients with chronic renal insufficiency. Patients treated with dialysis have a 10-20 times higher risk of developing cardiovascular disease than the general population. Patients with chronic kidney disease, apart from the usual, traditional risk factors for cardiovascular disease (age, diabetes, cigarette smoking, hypertension, positive family history), have additional risk factors, characteristic of the uremic syndrome, which are divided into the hemodynamic (anemia, retention of Na and H2O, AV fistula) and metabolic (hypoalbuminemia, hyperhomocysteinemia, oxidative stress, microinflammation, secondary hyperparathyroidism). The risk for cardiovascular disease may differ in patients on continuous ambulatory peritoneal dialysis and hemodialysis patients; especially in patients who remain on peritoneal dialysis for more than two years and which eventually lose their residual renal function. A part of cardiovascular damage in patients treated with dialysis is caused by the application of residual renal therapy. Therefore the question, whether hemodialysis or peritoneal dialysis is more harmful to dialysis patient, is very important.

Objectives: To identify the most frequent traditional and nontraditional risk factors for cardiovascular disease in patients on chronic dialysis (hemodialysis and continuous ambulatory peritoneal dialysis). To examine whether there is a difference in the frequency of risk factors for cardiovascular disease in patients on hemodialysis and continuous ambulatory peritoneal dialysis.

Design & Methodology: We conducted the prospective study that included 50 patients who were treated with chronic dialysis (hemodialysis and continuous ambulatory peritoneal dialysis). Subjects were divided into two groups; the test group: patients who were treated with continuous ambulatory peritoneal dialysis and the control group: patients who were treated with chronic hemodialysis. All the patients were taken anamnestic data, biochemical blood analysis, serum homocysteine ​​levels and underwent complete physical examination. The obtained data were submitted to statistical analysis using Student's t test and Chi square test. The statistical hypotheses were tested at α = 0.05, i.e. the difference between the groups was considered significant if p <0.05.

Results: The test group consisted of 15 subjects who were treated with continuous ambulatory peritoneal dialysis; the control group consisted of 35 subjects who were treated with chronic hemodialysis. The average age in the test group was 47.33 ± 13.86 years, the mean duration of continuous ambulatory peritoneal dialysis was 42.6 ± 3.72 months. The average age in the control group was 54.74 ± 16.08 years; the mean duration of hemodialysis duration was 79.05± 6.49 months. In the test group there was 5 (33.3%) men and 10 (66.7%) women; in the control group there was 17 (48.57%) men and 18 (51.43%) women.
Table 1 shows the prevalence of traditional risk factors for cardiovascular diseases by groups, there was no statistically significant difference between the test and control group.

Table 1. The prevalence of traditional risk factors for cardiovascular diseases by groups

 

Type of dialysis

 

Peritoneal

n = 15

Hemodialysis

n = 35

Smoking

2 (13,33%)

10 (28,57%)

Hypertension

10 (66,67%)

21 (60%)

Hyperlipidemia

8 (53,33%)

11 (31,40%)

Diabetes mellitus

4 (26,67%)

4 (11,43%)

Among the groups, there was no statistically significant difference between the test and control group in the incidence of anemia as non-traditional risk hemodynamic factor for cardiovascular disease. An anemia was diagnosed in 12 (80%) patients of the test group and in 31 (88.6%) patients of the control group (p - 0722). Table 2 presents the nontraditional metabolic risk factors for cardiovascular diseases by groups. There was a significant difference in central tendency for homocysteine ​​(p <0.002). Homocysteine ​​values ​​were higher in the control group compared to the test group.

Table 2: The nontraditional metabolic risk factors for cardiovascular diseases by groups

 

                         Type of dialysis

 

Peritoneal

n = 15

Hemodialysis

n = 35

Hyperhomocysteinameia

9 (60.0 %)

27 (94.28%)

Hypoalbuminemia

6 (40.0 %)

9 (25.7 %)

Microinflamation (CRP)

8 (53.33%)

16 (45.71%)

Secondary hyperparathyroidism was verified in 17 (48.57%) patients treated with hemodialysis, and in 6 (40%) patients treated with continuous ambulatory peritoneal dialysis. There was no statistically significant difference in parathyroid hormone values ​​between the groups (p 0.986).
Conclusion: In our study we did not find statistically significant differences in the prevalence of traditional and nontraditional risk factors for cardiovascular disease among patients treated with continuous ambulatory peritoneal dialysis and hemodialysis, except for the frequency of hyperhomocysteinemia, which was significantly more prevalent among patients on hemodialysis compared to patients treated with continuous ambulatory peritoneal dialysis.
The most common traditional risk factors for cardiovascular disease in patients of both groups were hypertension and hyperlipidemia.
Anemia was present in 12 (80%) patients from the test group and 31 (88.6%) patients from the control group. The most common nontraditional metabolic risk factor for the occurrence of cardiovascular disease in patients of both groups was hyperhomocysteinemia.