Predictors of cardiovascular disease in peritoneal dialysis patients: A Prospective longitudinal cohort study

The present study aimed to investigate the incidence rate and possible predictors of cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). Methods. This prospective longitudinal cohort study included 133 ESRD patients treated with CAPD between 2012 and 2019. The study was conducted in two phases. In the first phase, key patient demographic, clinical, and laboratory data, including the incidence of cardiovascular disease, were collected at baseline. In the second phase, an assessment of potential predictors of CVD in PD patients was performed. Baseline patient characteristics were used as potential predictors in this study. The mean duration of the prospective study was 28.2 ± 7.1 months, corresponding to 249.2 patient-years. Univariate and multivariate Cox proportional hazard regression and ROC analysis were performed to estimate predictors of CVD events. The primary end-point (newly diagnosed cardiovascular disease) was determined at the end of the study. Statistical processing of the results obtained was performed with "MedCalc," version 19.3 (Ostend, Belgium). Results. One hundred and three PD patients were included in the final analysis. During the study period, a significant increase (by 82%) in the frequency of all CVDs was observed (р < 0.0001), more than twice as frequent in heart failure (HF) (р < 0.0001) and atrial fibrillation (AF) (р= 0.0156). The primary endpoint was observed in 49 events: newly diagnosed HF in 21 (20.4%) patients, coronary artery disease in 9 (8.7%) patients, AF in 7 (6.8%) patients, acute myocardial infarction in 5 (4.9%) patients, another coronary heart disease in 7 (6.8%) patients. The incidence rate of CVD and HF was 19.66 and 8.43 per 100 patient-years, respectively. Multivariate Cox regression analysis indicated that hyperhydration (HR=4.2; 95% CI: 2,.2 - 7.3), diabetes mellitus as the primary cause of ESRD (HR=2.5; 95% CI: 1.3 - 4.3), history of MRSA colonization (HR=1.4; 95% CI: 1.2 - 1.7) and age (HR=1.03; 95% CI: 1.004 - 1.05) are independent predictors of all new-onset cardiovascular events in ESRD patients, treated with CAPD. ​A total of 44 patients (42.7%) died during the study period. The incidence rates of all-cause mortality were 17.67 per 100 patient-years. The most common cause of mortality was CVD, accounting for 50.0% of all events (8.82 per 100 patient-years). Conclusions. This prospective longitudinal study demonstrates that treatment with PD is associated with an increased incidence of CVD. Hyperhydration, diabetes mellitus, history of MRSA colonization, and age over 55 years are independent predictors of new-onset CVD in PD patients.