What are the comparative drivers of cardiovascular mortality and adverse outcomes between peritoneal dialysis and hemodialysis in patients with end-stage kidney disease?
Despite differing mechanisms of cardiovascular harm—ischemia and loss of residual renal function in hemodialysis versus metabolic and volume issues in peritoneal dialysis—overall patient survival remains broadly equivalent between the two modalities.
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.
Selby et al. (Tue,) studied this question.
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