Bitar Wisam, Helve Jaakko, Haapio Mikko, Rauta Virpi, Honkanen Eero, Finne Patrik
Nephrology Department, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Finnish Registry for Kidney Diseases, Finnish Kidney and Liver Association, Helsinki, Finland.
Clin J Am Soc Nephrol. 2025 Jan 1;20(1):81-87. doi: 10.2215/CJN.0000000579. Epub 2024 Nov 19.
We observed a comparable cumulative incidence of major adverse cardiovascular event (MACE) in in-center hemodialysis (IC-HD) and continuous ambulatory peritoneal dialysis (PD) patients, which was higher than in automated PD and home hemodialysis patients. After adjustment for confounders, there was no difference in risk of MACE between patients on home dialysis modalities and IC-HD. Compared with IC-HD, PD was associated with lower risk of MACE among female patients and higher risk among male patients.
Among dialysis patients, cardiovascular events are the leading cause of death. Little is known about how the frequency and type of cardiovascular events differ between various dialysis modalities. We compared risk of major adverse cardiovascular events (MACEs) in patients who started continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), and home hemodialysis with in-center hemodialysis (IC-HD) patients.
We included 968 patients who entered dialysis in the Helsinki-Uusimaa health care district in Finland from 2004 to 2017, of whom 162 were on CAPD, 229 on APD, 145 on home hemodialysis, and 432 on IC-HD at day 90 from the start of dialysis. MACE was defined as acute myocardial infarction, stroke, or death due to cardiovascular disease. The cumulative incidence of the first MACE was calculated. Cox regression was used to compare risk of MACE between dialysis modalities with adjustment for potential confounding factors.
Of all 968 patients, 195 (20%) experienced a MACE during the entire follow-up and 62 (6%) during the first year of follow-up. The cumulative incidence of first MACE was similar in IC-HD and CAPD patients and higher than that in APD and home hemodialysis patients. After adjustment for possible confounders, the hazard ratio (HR) of MACE was 1.22 (95% confidence intervals [CIs], 0.73 to 2.05) for CAPD, 0.86 (95% CI, 0.47 to 1.57) for APD and 0.67 (95% CI, 0.30 to 1.50) for home hemodialysis compared with IC-HD. Unexpectedly, compared with IC-HD, peritoneal dialysis associated with lower risk of MACE among female patients (HR, 0.37; 95% CI, 0.14 to 0.99) and higher risk among male patients (HR, 1.80; 95% CI, 1.11 to 2.92).
In this cohort, the risk of MACE was comparable across in-center and home dialysis modalities. However, the result differed between male patients and female patients, which requires further research.
我们观察到，接受中心血液透析（IC-HD）和持续性非卧床腹膜透析（PD）的患者发生主要不良心血管事件（MACE）的累积发生率相当，且高于接受自动化腹膜透析和家庭血液透析的患者。在对混杂因素进行调整后，接受家庭透析模式的患者与接受IC-HD的患者发生MACE的风险没有差异。与IC-HD相比，PD在女性患者中与较低的MACE风险相关，而在男性患者中与较高的风险相关。
在透析患者中，心血管事件是主要死因。对于不同透析模式中心血管事件的频率和类型如何不同，人们了解甚少。我们比较了开始接受持续性非卧床腹膜透析（CAPD）、自动化腹膜透析（APD）和家庭血液透析的患者与接受中心血液透析（IC-HD）的患者发生主要不良心血管事件（MACE）的风险。
我们纳入了2004年至2017年在芬兰赫尔辛基-乌西马地区医疗保健区开始透析的968例患者，其中162例接受CAPD，229例接受APD，145例接受家庭血液透析，432例在透析开始后第90天接受IC-HD。MACE定义为急性心肌梗死、中风或心血管疾病导致的死亡。计算首次发生MACE的累积发生率。使用Cox回归比较不同透析模式下MACE的风险，并对潜在混杂因素进行调整。
在所有968例患者中，195例（20%）在整个随访期间发生了MACE,62例（6%）在随访的第一年发生了MACE。IC-HD和CAPD患者首次发生MACE的累积发生率相似，且高于APD和家庭血液透析患者。在对可能的混杂因素进行调整后，与IC-HD相比，CAPD发生MACE的风险比（HR）为1.22（95%置信区间[CI]，0.73至2.05），APD为0.86（95%CI，0.47至1.57），家庭血液透析为0.67（95%CI，0.30至1.50）。出乎意料的是，与IC-HD相比，腹膜透析在女性患者中与较低的MACE风险相关（HR，0.37；95%CI，0.14至0.99），而在男性患者中与较高的风险相关（HR，1.80；95%CI，1.11至2.92）。
在这个队列中，中心透析和家庭透析模式下MACE的风险相当。然而，男性患者和女性患者的结果不同，这需要进一步研究。
