Sharabas Islam, Siddiqi Nauman
Department of Nephrology, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
Saudi J Kidney Dis Transpl. 2016 Jul-Aug;27(4):692-700. doi: 10.4103/1319-2442.185225.
This study was performed to assess the cardiovascular disease (CVD) risk factors in the prevalent peritoneal dialysis (PD) and hemodialysis (HD) patients and their association with cardiovascular events (CVEs) in a Saudi end-stage renal disease cohort. This was a prospective, observational, single-center study. A total of 192 patients were screened of which 157 patients were eligible (HD = 121, PD = 36). All patients underwent assessment of cardiovascular risk factors at the time of enrollment including electrocardiogram and echocardiography, lipid profile, homocysteine, and insulin levels. Patients were followed for one year and CVE [acute myocardial infarction, cerebrovascular accident (CVA), and congestive heart failure] and mortality were recorded. SPSS ® Version 16 was used for the analysis. T-test and ANOVA were used for continuous data; categorical data were analyzed using Chi-square and Mann-Whitney tests. The primary end-point of CVE and all-cause mortality was compared in the two groups using Kaplan-Meier survival analysis. HD patients were older and had been longer on dialysis. While PD patients had higher urine output and better Kt/V values, they were more edematous and using more antihypertensive medications. PD patients also had a lower ejection fraction (EF). Age >57 years and the use of more than one antihypertensive medication were associated with higher risk of CVE, while EF >53 was found to be protective. Age >57 years and EF <53 at enrollment were predictive of all-cause mortality. Saudi patients undergoing PD have worse CVD risk profiles compared to HD patients. Age less than 57 years and an EF >53 were cardioprotective.
本研究旨在评估沙特终末期肾病队列中，腹膜透析（PD）和血液透析（HD）患者的心血管疾病（CVD）危险因素及其与心血管事件（CVE）的关联。这是一项前瞻性、观察性、单中心研究。共筛选了192例患者，其中157例符合条件（HD = 121例，PD = 36例）。所有患者在入组时均接受了心血管危险因素评估，包括心电图、超声心动图、血脂谱、同型半胱氨酸和胰岛素水平。对患者进行了一年的随访，并记录了CVE[急性心肌梗死、脑血管意外（CVA）和充血性心力衰竭]及死亡率。使用SPSS®16版进行分析。连续数据采用t检验和方差分析；分类数据采用卡方检验和曼-惠特尼检验进行分析。使用Kaplan-Meier生存分析比较两组的CVE和全因死亡率的主要终点。HD患者年龄较大，透析时间更长。虽然PD患者尿量较多且Kt/V值较好，但他们水肿更严重，使用的降压药物更多。PD患者的射血分数（EF）也较低。年龄>57岁和使用一种以上降压药物与CVE风险较高相关，而EF>53被发现具有保护作用。入组时年龄>57岁和EF<53可预测全因死亡率。与HD患者相比，接受PD治疗的沙特患者的CVD风险状况更差。年龄小于57岁和EF>53具有心脏保护作用。
