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Is peritoneal dialysis superior to hemodialysis as far as cardiovascular risk? Another unsolved dilemma for maintenance dialysis

      The Nephrology field has been vexed by many difficult questions over the years and one of them is what is the best renal replacement therapy (RRT) as far as cardiovascular risk for patients receiving dialysis. In this issue, Sun and coworkers [
      • Timmerman N.
      • de Kleijn D.P.V.
      • de Borst G.J.
      • et al.
      Family history and polygenic risk of cardiovascular disease: Independent factors associated with secondary cardiovascular events in patients undergoing carotid endarterectomy.
      ] probed the National Health Insurance Research Database in Taiwan to investigate whether peritoneal dialysis (PD) and hemodialysis (HD) are associated with a different degree of risk of acute myocardial infarction (AMI). According to the database 86,215 patients began RRT between January 1, 1998 and December 31, 2010. Among these, the authors matched 5513 pairs treated with either PD or HD using a propensity score. All patients with a prior history of myocardial infarction and malignancy were excluded from the match. The main information that emerged from the analyses is that PD was associated with a lower risk of AMI than HD (incidence rate: 8.35 vs 9.71 per 1000-person year) even after adjusting for confounders. The difference became apparent after 4 years from beginning RRT; prior to that time, the event rate was similar for the 2 modalities.

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