China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis
1 Division of Nephrology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, China
2 Key Lab for Organ Failure Research, Ministry of Education, Guangzhou, China
3 Division of Nephrology, The First Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
4 Division of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
5 Department of Biostatistics, Southern Medical University, Guangzhou, China
6 Division of Nephrology, Changzheng Hospital, Secondary Military Medical University, Shanghai, China
7 Division of Nephrology, The First People’s Hospital, Wuhan, China
8 Division of Nephrology, Guangdong General Hospital, Guangzhou, China
9 Division of Nephrology, The 309th Hospital of People’s Liberation Army, Beijing, China
10 Division of Nephrology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
11 Division of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
BMC Nephrology 2012, 13:94 doi:10.1186/1471-2369-13-94Published: 30 August 2012
Cardiovascular disease (CVD) is the main cause of death in patients on chronic dialysis. The question whether dialysis modality impacts cardiovascular risk remains to be addressed. China Collaborative Study on Dialysis, a multi-centers cohort study, was performed to evaluate cardiovascular morbidity during maintenance hemodialysis (HD) and peritoneal dialysis (PD).
The cohort consisted of chronic dialysis patients from the database of 9 of the largest dialysis facilities around China. The inclusion period was between January 1, 2005, and December 1, 2010. Cardiovascular morbidity was defined as the presence of clinically diagnosed ischemic heart disease, heart failure, peripheral vascular disease, and/or stroke. The patients who had cardiovascular morbidity before initiation of dialysis were excluded. Data collection was based on review of medical record.
A total of 2,388 adult patients (1,775 on HD and 613 on PD) were enrolled. Cardiovascular morbidity affected 57% patients and was comparable between HD and PD patients. However, clinically diagnosed ischemic heart disease and stroke was more prevalent in PD than HD patients. When the patients were stratified by age or dialysis vintage, the cardiovascular morbidity was significantly higher in PD than HD among those aged 50 years or older, or those receiving dialysis over 36 months. Multivariate analysis revealed that the risk factors for cardiovascular morbidity had different pattern in PD and HD patients. Hyperglycemia was the strongest risk factor for cardiovascular morbidity in PD, but not in HD patients. Hypertriglyceridemia and hypoalbuminemia were independently associated with CVD only in PD patients.
Cardiovascular morbidity during chronic dialysis was more prevalent in PD than HD patients among those with old age and long-term dialysis. Metabolic disturbance-related risk factors were independently associated with CVD only in PD patients. Better understanding the impact of dialysis modality on CVD would be an important step for prevention and treatment.