Does hemodialysis compared to continuous ambulatory peritoneal dialysis increase arterial stiffness and cardiac dysfunction in patients with end-stage renal disease?
Hemodialysis is independently associated with increased arterial stiffness and more severe diastolic dysfunction compared to continuous ambulatory peritoneal dialysis in patients with end-stage renal disease.
BACKGROUND: Arterial stiffness determined by brachial-ankle pulse wave velocity (baPWV) has been established as a powerful predictor of cardiovascular mortality in hemodialysis (HD) patients. There are, however, few studies regarding the comparative impact of different renal replacement therapies (RRTs) on PWV. Therefore, we conducted a cross-sectional study to compare arterial wall properties and cardiac function between patients treated with continuous ambulatory peritoneal dialysis (CAPD) and those with HD who were matched for age, dialysis duration, and blood pressure. METHODS: baPWV and transthoracic echocardiography (TTE) were performed in HD patients (n = 23) after 1 h of midweek dialysis session and CAPD patients (n = 26) with empty abdomen after drainage of dialysate. The baseline data were retrospectively reviewed. RESULTS: baPWV was significantly higher in HD patients than in CAPD patients (18.1 +/- 2.8 vs. 16.1 +/- 2.7 m/s, p = 0.015). TTE revealed significantly increased E/E', left atrial volume index (LAVI), and inferior vena cava (IVC) diameter index in HD patients compared with CAPD patients (p < 0.05). In a multivariate regression analysis adjusted for dialysis modality, age, systolic BP, residual glomerular filtration rate, diabetes, and echocardiographic parameters, HD was independently associated with increased baPWV. CONCLUSION: This study showed that HD patients had significantly increased arterial stiffness and severe diastolic dysfunction compared with CAPD patients.
Chang et al. (2010) studied this question.