Following this, we will conduct analyses of the main effect of the interventions on dialysis session stability. We will also conduct secondary analyses of the impact of the interventions on quality of life, fluid and dialysis adherence, symptoms, hospitalization, and mortality.
The contributions of this research include translating evidence-based interventions into the context of hemodialysis session safety, and generating critical comparative effectiveness information regarding hemodialysis safety interventions. Study results will inform hemodialysis facilities regarding whether to pursue provider-focused or patient-focused safety interventions, or both.
Results will also inform patients who want to become more engaged in safety-related decisions and activities. Ultimately, we believe that by engaging patients and providers, our efforts hold promise for effectively changing routine practice and reducing hemodialysis complications.
Sudden cardiac death in hemodialysis patients: an in-depth review. Am J Kidney Dis. McIntyre CW. Haemodialysis-induced myocardial stunning in chronic kidney disease - a new aspect of cardiovascular disease.
Blood Purif. Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Hemodialysis-induced cardiac injury: determinants and associated outcomes. Blood volume controlled hemodialysis in hypotension-prone patients: a randomized, multicenter controlled trial. Kidney Int. Preventing dialysis hypotension: a comparison of usual protective maneuvers.
Prediction of hypotension in hemodialysis patients. Physiological measurement. Patients' perspective of haemodialysis-associated symptoms. Nephrol Dial Transplant. Hayes W, Hothi DK. Intradialytic hypotension. Pediatr Nephrol. Twardowski ZJ. Treatment time and ultrafiltration rate are more important in dialysis prescription than small molecule clearance. Intradialytic hypotension: frequency, sources of variation and correlation with clinical outcome.
Practices related to fluid volume that are important for dialysis patients' health
Improving clinical outcomes among hemodialysis patients: a proposal for a "volume first" approach from the chief medical officers of US dialysis providers. She is co-principal investigator of the study described in this article. This was noted by Szeto CC et al. In our study, 99 patients were diabetic and CV disease was more prominent among the diabetic PD population on both univariate and multivariate analyses..
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Another cardiovascular risk factor specific to peritoneal dialysis arises from the presence of glucose degradation products in conventional peritoneal dialysis solutions, leading to formation of advanced glycation end products. Better survival has been described in retrospective but not randomized studies. These solutions may, however, reduce peritoneal neoangiogenesis and thereby attenuate the risk of ultrafiltration failure that ultimately leads to hypertension and volume overload.
A recent study by Han et al. The authors in that publication alert for the need for randomized trials to confirm and better evaluate these findings. APD has been increasingly used in many parts of the world, essentially due to lifestyle flexibility offered by this modality of PD and not only medical concerns for example, lower incidence of peritonitis, fewer mechanical complications, faster decline in RRF and less sodium removal eventually associated with APD or financial burden.
Ortega et al. Nonetheless, large randomized controlled trials are necessary to determine the possible association between CV disease and PD modalities.. It is readily accepted that patients on dialysis are at an increased risk for accelerated atherosclerosis, in part due to the existence of inflammation which is multifactorial in nature infections, malnourishment, bioincompatible dialysis solutions and CV disease.
Hyperphosphatemia and an increased calcium-phosphorus product are well-known risk factors for mortality and CV death in both HD and PD patients, 37 also contributing to an enhanced risk of vascular, valvular and other tissue calcifications. RRF in PD patients may play an important part in extracellular volume control. Fluid overload may be explained by the loss of RRF, which is in itself a significant predictor of mortality, 33 as well as contribute to the development of LVH in these patients.
A statistically significant difference was found between patients with CV disease and those without CV disease on univariate analysis with regard to daily urine output On univariate analysis anuria closely approached statistical significance Limitations to this study include its retrospective nature, which can be a source of bias and confound, and the fact that prevalent patients may not be representative of all cases. In fact, it is possible that by studying only the prevalent PD population on 31 December , many patients who potentially transferred to HD or transplantation or died due to CV disease were overlooked, thereby underestimating the true prevalence of CV disease in Portugal.
Clinically subjective definitions for the various types of CV disease are another probable source of misconception regarding the prevalence of CV disease.
Additionally, treatment or correction of identified fluid overload could reverse congestive heart failure, thereby ameliorating the condition and explaining the low prevalence of congestive heart failure on 31 December in our population, however this was not addressed specifically.. Although certain risk factors for CV disease, such as older age and male gender, are not modifiable, nephrologists need to be conscious of those disorders whose management could diminish the pronounced burden of CV disease existent in this population, in order to reduce the high morbidity and mortality rates and thus improve long-term outcomes in the PD population..
The authors declare that there is no conflict of interest associated with this manuscript.. Table 1. Table 2. Traditional risk factors associated with the presence of cardiovascular disease.. Table 3. Risk factors related to chronic kidney disease associated with the presence of cardiovascular disease.. Table 4. Risk factors related to peritoneal dialysis associated with the presence of cardiovascular disease.. Home Articles in press Archive. ISSN: Previous article Next article. March Pages DOI: Cardiovascular risk in peritoneal dialysis ' A Portuguese multicenter study.
Download PDF. This item has received. Article information. Show more Show less. Palabras clave:. Riesgo cardiovascular. Peritoneal dialysis. Cardiovascular risk. The secondary goal was to establish clinical and laboratorial parameters most associated with the presence of CV disease in this population. The remaining variables associated with CV disease in univariate analysis lost statistical significance in multivariate analysis.
In our study, 99 patients were diabetic and CV disease was more prominent among the diabetic PD population on both univariate and multivariate analyses. Nonetheless, large randomized controlled trials are necessary to determine the possible association between CV disease and PD modalities. Additionally, treatment or correction of identified fluid overload could reverse congestive heart failure, thereby ameliorating the condition and explaining the low prevalence of congestive heart failure on 31 December in our population, however this was not addressed specifically.
Although certain risk factors for CV disease, such as older age and male gender, are not modifiable, nephrologists need to be conscious of those disorders whose management could diminish the pronounced burden of CV disease existent in this population, in order to reduce the high morbidity and mortality rates and thus improve long-term outcomes in the PD population. Is peritoneal dialysis kinder for the heart? Perit Dial Int ;31 2 Epidemiology of cardiovascular disease in chronic renal disease.
Curr Diab Rep ; Cardiovascular risk in the peritoneal dialysis patient. Nat Rev Nephrol ;6 8 Risk factors for cardiovascular disease in patients undergoing peritoneal dialysis. Perit Dial Int ;27 Suppl 2 :S Agostino RB. Section some risk factors related to the annual incidence of cardiovascular disease and death in pooled repeated biennial measurements.
Hypertension in peritoneal dialysis patients: epidemiology, pathogenesis, and treatment. J Am Soc Hypertens ;5 3 The information you enter will appear in your e-mail message and is not retained by Medical Xpress in any form.
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