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Comparison of cardiovascular mortality in hemodialysis versus peritoneal dialysis

  • Nephrology - Review
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Abstract

Purpose

Cardiovascular disease is a significant cause of morbidity and mortality in dialysis patients. With the increasing prevalence of dialysis patients, there is a need to systematically identify the epidemiology of cardiovascular disease in hemodialysis and peritoneal dialysis patients.

Methods

A meta-analysis was conducted in reference to the MOOSE and PRISMA guidelines. Database searches were conducted on Medline and Embase on 17 March 2020. Meta-analysis of proportions was used to summarize the overall prevalence of events. Pairwise comparisons were used to compare between hemodialysis and peritoneal dialysis, and meta-regression was applied to identify the factors influencing disease.

Results

A total of 28 studies were included in the review and prevalence of cardiovascular disease events including coronary artery disease, coronary artery complications, congestive heart failure, peripheral arterial disease, atrial fibrillation, and cardiovascular mortality were summarized. Atrial fibrillation (RR 1.287 CI 1.154–1.436, p < 0.001), congestive heart failure (RR 1.229 CI 1.074–1.407, p = 0.003), and peripheral arterial disease (RR 1.132 CI 1.021–1.255, p = 0.019) were more common in hemodialysis patients, but cardiovascular mortality was lower in hemodialysis relative to peritoneal dialysis patients. (RR 0.892 CI 0.828–0.960, p = 0.002).

Conclusion

The authors have found fewer cardiovascular events but higher cardiovascular mortality in patients on PD as compared to those on HD. Future research is required to establish the causality between dialysis modality and the cardiovascular outcomes described.

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Author notes

  1. Cheng Han Ng and Zhi Hao Ong had equal contribution.

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore

    Cheng Han Ng, Zhi Hao Ong, Hersharan Kaur Sran & Teo Boon Wee

  2. Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore

    Hersharan Kaur Sran & Teo Boon Wee

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  1. Cheng Han Ng
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  2. Zhi Hao Ong
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  4. Teo Boon Wee
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Contributions

CHN: Conceptualisation, methodology, data analysis, writing of original draft. ZHO: Conceptualisation, methodology, data analysis, writing of original draft. HKS: Supervision, review and editing, methodology. TBW: Conceptualisation, supervision, review and editing, resources.

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Correspondence to Cheng Han Ng or Zhi Hao Ong.

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Ng, C.H., Ong, Z.H., Sran, H.K. et al. Comparison of cardiovascular mortality in hemodialysis versus peritoneal dialysis. Int Urol Nephrol 53, 1363–1371 (2021). https://doi.org/10.1007/s11255-020-02683-9

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