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Inflammation and Fibrosis |
Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
Correspondence to: R. Pecoits-Filho, Center for Health and Biological
Sciences, Imaculada Conceição, 1155 Curitiba, PR 80215-901
Brazil.
r.pecoits{at}pucpr.br
Cardiovascular (CV) disease is the main cause of death in peritoneal
dialysis (PD) patients, but the mechanisms mediating the increased CV risk
observed in this group of patients are still largely unknown, which limits the
perspective on effective therapeutic strategies. Patients on PD are already
exposed to a number of traditional risk factors from the start of their
chronic kidney disease (CKD), because many of those risk factors are common to
CV disease and CKD alike. As renal dysfunction progresses, CKD-related risk
factors are introduced, changing the profile of both the CV disease and the
markers of risk. In this phase, which usually starts when glomerular
filtration rate falls below 60 mL/min, the list of risk factors is expanded to
include disturbances of mineral metabolism, anemia, fluid overload, uremic
toxicity, and increased signs of oxidative stress and inflammation. Although
many of the risk factors linked to CV burden are not related to the dialytic
procedure, additional harm is introduced after the initiation of
PD—with, for example, the presence of chronic infections and factors
related to PD fluids, particularly reabsorption of glucose. In the present
article, we review the impact of the novel risk factors introduced with the
initiation of PD therapy, and we propose potential therapeutic strategies
(which remain to be tested) for reducing CV mortality in this group of
patients.
KEY WORDS: KEY WORDS:; Cardiovascular disease; risk factors; glucose absorption.
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