Balafa O, Krediet R T
Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece.
Minerva Urol Nefrol. 2012 Sep;64(3):153-62.
Cardiovascular (CV) death is the most frequent cause of dying in peritoneal dialysis (PD) patients. Risk factors include not only those that can be present in the general population, but also those related to the presence of end-stage renal disease (ESRD) and factors that are specific for PD modality. Hypertension is the most important general risk factor in PD patients, while obesity remains controversial. Inflammation, malnutrition, calcifications and probably endothelial dysfunction and oxidative stress are all CV risk factors present in ESRD that contribute to mortality in PD patients. Additional CV risk factors in PD are related to the glucose load, leading to increasing insulin resistance and a more atherogenic lipid profile. The presence of glucose degradation products in conventional dialysis solutions is mainly related to the development of peritoneal abnormalities, but not directly to cardiovascular disease. Loss of residual renal function and ultrafiltration failure promote overhydration, which is the most important PD-related risk factor for CV disease.
心血管（CV）死亡是腹膜透析（PD）患者最常见的死亡原因。危险因素不仅包括一般人群中可能存在的因素，还包括与终末期肾病（ESRD）存在相关的因素以及腹膜透析方式特有的因素。高血压是PD患者最重要的一般危险因素，而肥胖仍存在争议。炎症、营养不良、钙化以及可能的内皮功能障碍和氧化应激都是ESRD中存在的心血管危险因素，这些因素导致PD患者死亡。PD中额外的心血管危险因素与葡萄糖负荷有关，导致胰岛素抵抗增加和动脉粥样硬化性脂质谱改变。传统透析液中葡萄糖降解产物的存在主要与腹膜异常的发生有关，但与心血管疾病无直接关系。残余肾功能丧失和超滤失败会促进水过多，这是与PD相关的心血管疾病最重要的危险因素。
