Risk factors for vascular complications in patients on peritoneal dialysis.

The major cause of death in patients on peritoneal dialysis (PD) is vascular complications, including congestive heart failure, cerebrovascular disease, and myocardial infarction. To clarify the risk factors for vascular complications in patients on PD, we investigated the clinical course of PD in patients with and without cardiovascular and cerebrovascular complications. From among 327 end-stage renal disease (ESRD) patients initiated onto PD from April 1995 to March 2005 in the Kidney and Dialysis Center, Saitama Medical School, 8 developed de novo cardiovascular and cerebrovascular complications (CVD group--mean age: 58.3 +/- 4.9 years; 5 men, 3 women). We compared data pertaining to body weight, blood pressure, blood chemistry, and cardiothoracic ratio (CTR) between the CVD group and an age- and sex-matched control group (n = 8; mean age: 57.5 +/- 4.0 years). At baseline, we observed no significant differences of body weight, blood pressure, CTR, hemoglobin, total cholesterol, triglycerides, HbA1c, or serum albumin between the CVD group and the control group. In the CVD group, 1 month before the onset of CVD, serum albumin was significantly lower than in the control group (2.9 +/- 0.2 g/dL vs. 3.8 +/- 0.1 g/dL, p = 0.0029). Body weight in the CVD group was significantly lower than in the control group (56.8 +/- 2.8 kg vs. 63.0 +/- 2.9 kg, p = 0.0086). No significant differences were observed in blood pressure, CTR, hemoglobin, total cholesterol, triglycerides, or HbA1c between the groups. A decrease in serum albumin after commencement of dialysis is an important risk factor for, and a strong predictor of vascular complications in patients on PD. To help prevent vascular complications, it is important to monitor and manage serum albumin in patients on PD.