Writen by Jasna Trbojevic-Stankovic
Reviewed by Sydney Tang
Already approximately 25 centuries BC Shennong defined discoordination between the kidney and the heart as an ailment. Nowadays, we know that as high as 54% of all deaths among dialysis and transplant recipients are due to cardiovascular (CV) causes . Population studies showed that albuminuria and estimated glomerular filtration (eGFR) rate are closely associated with all-cause as well as CV mortality . In addition, sleep apnea strongly correlates with proteinuria in chronic kidney disease (CKD) patients . In hemodialysis (HD) patients, for instance, there is a four-fold higher likelihood of sleep apnea and severe nocturnal hypoxemia as compared to matched controls . Moreover, in peritoneal dialysis (PD) patients, sleep apnea is a risk predictor of CV morbidity and mortality .
Stroke risk in dialysis patients
The risk of developing a stroke dramatically increases from about two months before and stabilises only approximately six months after the commencement of incident dialysis . One of the plausible mechanisms for this observation is a significant reduction in global and regional cerebral blood flow (CBF) induced by HD . Furthermore, the CBF decline correlates with the intradialytic cognitive dysfunction .
Compared to HD, PD carries a 16% lower risk of hemorrhagic stroke, although the overall risks of all types of stroke including ischemic stroke is not different . In addition, PD is associated with better cognitive functions and a lower incidence of dementia than HD [10, 11].