Cardiovascular disease is responsible for at least half of all deaths in end-stage renal disease patients on maintenance dialysis and is attributed to the very high prevalence of left ventricular hypertrophy and dysfunction, cardiac failure, coronary artery disease and other atherosclerotic complications. Apart from traditional risk factors such as smoking, hypertension, diabetes and dyslipidemia, these patients are at risk of accelerated atherosclerosis and other cardiovascular complications as a result of non-traditional risk factors such as inflammation, anemia, increased oxidative stress, hyperparathyroidism and excessive calcium phosphorus load. In recent years, there is an increasing recognition of calcification complications in patients on dialysis. However, the importance and prognostic value of calcification in patients on peritoneal dialysis is not known. Residual renal function has a significant contribution to the overall survival in patients on peritoneal dialysis but whether it is in any way related to cardiovascular death and complications in patients on peritoneal dialysis is not known. Inflammation is highly prevalent in dialysis patients and is considered to play a pathogenic role in cardiovascular disease. In this thesis, we evaluated some of these relatively novel factors that may predispose peritoneal dialysis patients to an increased risk of cardiovascular complications and mortality, including calcification, loss of residual renal function and inflammation. A number of important conclusions were drawn from these studies. First, valvular calcification is a marker of atherosclerosis and shows important associations with malnutrition and inflammation and is an important predictor of mortality and cardiovascular deaths in peritoneal dialysis patients. Second, inflammation, as denoted by either C-reactive protein or vascular cell adhesion molecule-1 shows an important association with residual renal function and cardiac hypertrophy and is associated with mortality and cardiovascular risk in peritoneal dialysis patients. Third, loss of residual renal function is an important cardiovascular risk and combines adversely with C-reactive protein and cardiac hypertrophy to increase cardiovascular mortality in peritoneal dialysis patients. Fourth, resting hypermetabolism and the malnutrition, inflammation and atherosclerosis syndrome are associated phenomena that parallel the decline of residual renal function and predict an increased mortality and cardiovascular death in peritoneal dialysis patients.
| Identifer | oai:union.ndltd.org:ADTP/187046 |
| Date | January 2005 |
| Creators | Wang, Angela Yee-Moon, Medicine, UNSW |
| Publisher | Awarded by:University of New South Wales. Medicine |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | Copyright Angela Yee-Moon Wang, http://unsworks.unsw.edu.au/copyright |
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