Division of Nephrology, Department of Medicine, Academic Medical Centre University of Amsterdam, P. O. Box 22700, 1100 DE Amsterdam, The Netherlands.
Nat Rev Nephrol. 2010 Aug;6(8):451-60. doi: 10.1038/nrneph.2010.68. Epub 2010 Jun 22.
Cardiovascular death is the most frequent cause of death in patients on peritoneal dialysis. Risk factors for cardiovascular death in these patients include those that affect the general population as well as those related to end-stage renal disease (ESRD) and those that are specific to peritoneal dialysis. The development of overhydration after loss of residual renal function is probably the most important cardiovascular risk factor specific to peritoneal dialysis. The high glucose load associated with peritoneal dialysis may lead to insulin resistance and to the development of an atherogenic lipid profile. The presence of glucose degradation products in conventional dialysis solutions, which leads to the local formation of advanced glycation end products, is also specific to peritoneal dialysis. Other risk factors that are not specific to peritoneal dialysis but are related to ESRD include calcifications and protein-energy wasting. When present together with inflammation and atherosclerosis, protein-energy wasting is associated with a marked increase in the risk of cardiovascular death. Obesity is not associated with increased cardiovascular risk in patients on any form of dialysis. Left ventricular hypertrophy and increased arterial stiffness are the most important risk factors for cardiovascular events in the general population.
心血管死亡是腹膜透析患者最常见的死亡原因。这些患者心血管死亡的危险因素包括影响普通人群的因素、与终末期肾病（ESRD）相关的因素以及与腹膜透析相关的特定因素。残余肾功能丧失后发生的水过多可能是腹膜透析特有的最重要的心血管危险因素。与腹膜透析相关的高葡萄糖负荷可能导致胰岛素抵抗和形成动脉粥样硬化脂质谱。在常规透析液中存在葡萄糖降解产物，导致局部形成晚期糖基化终产物，这也是腹膜透析特有的。其他非腹膜透析特有的但与 ESRD 相关的危险因素包括钙化和蛋白质能量消耗。当与炎症和动脉粥样硬化一起存在时，蛋白质能量消耗与心血管死亡风险的显著增加相关。肥胖与任何形式透析患者的心血管风险增加无关。左心室肥厚和动脉僵硬增加是普通人群心血管事件的最重要危险因素。
