Research article

BMC Nephrology

, 13:94

Open Access This content is freely available online to anyone, anywhere at any time.

China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysis

  • Fanfan HouAffiliated withDivision of Nephrology, Nanfang Hospital, Southern Medical UniversityKey Lab for Organ Failure Research, Ministry of Education Email author 
  • , Jianping JiangAffiliated withDivision of Nephrology, Nanfang Hospital, Southern Medical UniversityKey Lab for Organ Failure Research, Ministry of Education
  • , Jianghua ChenAffiliated withDivision of Nephrology, The First Affiliated Hospital, Medical College of Zhejiang University
  • , Xueqing YuAffiliated withDivision of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University
  • , Qiugen ZhouAffiliated withDivision of Nephrology, Nanfang Hospital, Southern Medical UniversityKey Lab for Organ Failure Research, Ministry of Education
  • , Pingyan ChenAffiliated withDepartment of Biostatistics, Southern Medical University
  • , Changlin MeiAffiliated withDivision of Nephrology, Changzheng Hospital, Secondary Military Medical University
  • , Fei XiongAffiliated withDivision of Nephrology, The First People’s Hospital
  • , Wei ShiAffiliated withDivision of Nephrology, Guangdong General Hospital
    • , Wei ZhouAffiliated withDivision of Nephrology, The 309th Hospital of People’s Liberation Army
    • , Xusheng LiuAffiliated withDivision of Nephrology, Guangdong Provincial Hospital of Traditional Chinese Medicine
    • , Shiren SunAffiliated withDivision of Nephrology, Xijing Hospital, Fourth Military Medical University
    • , Di XieAffiliated withDivision of Nephrology, Nanfang Hospital, Southern Medical UniversityKey Lab for Organ Failure Research, Ministry of Education
    • , Jun LiuAffiliated withDivision of Nephrology, Nanfang Hospital, Southern Medical UniversityKey Lab for Organ Failure Research, Ministry of Education
    • , Ping ZhangAffiliated withDivision of Nephrology, The First Affiliated Hospital, Medical College of Zhejiang University
    • , Xiao YangAffiliated withDivision of Nephrology, The First Affiliated Hospital, Sun Yat-Sen University
    • , Yixiang ZhangAffiliated withDivision of Nephrology, Changzheng Hospital, Secondary Military Medical University
    • , Yanmin ZhangAffiliated withDivision of Nephrology, The First People’s Hospital
    • , Xinling LiangAffiliated withDivision of Nephrology, Guangdong General Hospital
    • , Zhimin ZhangAffiliated withDivision of Nephrology, The 309th Hospital of People’s Liberation Army
    • , Qizhan LinAffiliated withDivision of Nephrology, Guangdong Provincial Hospital of Traditional Chinese Medicine
    • , Yan YuAffiliated withDivision of Nephrology, Xijing Hospital, Fourth Military Medical University
    • , Shengjie WuAffiliated withDivision of Nephrology, Nanfang Hospital, Southern Medical UniversityKey Lab for Organ Failure Research, Ministry of Education
    • , Xin XuAffiliated withDivision of Nephrology, Nanfang Hospital, Southern Medical UniversityKey Lab for Organ Failure Research, Ministry of Education

Abstract

Background

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).

Method

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.

Result

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.

Conclusions

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.

Keywords

Cardiovascular morbidity Dialysis modality Risk factor