Cardiovascular disease in haemodialysis and peritoneal dialysis: arguments pro peritoneal dialysis

Cardiovascular disease is frequent in end-stage renal disease (ESRD) patients, and it is the major cause of morbidity [ 1 , 2 ] and mortality [ 3 ] in this population. It can manifest itself as ischaemic heart disease, congestive heart failure, atherosclerotic peripheral vascular disease [ 4 ] or cerebrovascular disease [ 5 ]. In the last decade, evidence has accrued that part of this cardiovascular damage might be due to renal replacement therapy (RRT) itself, and the question whether haemodialysis (HD) or peritoneal dialysis (PD) is more harmful than the other is, therefore, of high relevance. Some recent publications have suggested a worse outcome in PD as compared with HD patients [ 6 , 7 ] with congestive heart failure or coronary heart disease, pleading to avoid PD in cardiovascular-compromised patients. Are these results the confirmation that PD is a second-class treatment, or are we listening to the wrong heartbeat?