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Impact of dialysis adequacy on cardiac function in pediatric CAPD patients
S A Bakkaloğlu1, M Ekim, G Koçak
1Department of Pediatric Nephrology, Ankara University Faculty of Medicine, Turkey. sevcan@med.gazi.edu.tr
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Adequate dialysis therapy improves cardiac function in pediatric patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Enhanced dialysis clearance (Kt/V and TCCr) correlates with better cardiac structure and function, reducing risks associated with uremia.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Physiology
- Renal Replacement Therapy
Background:
- Left ventricular hypertrophy is a significant cause of morbidity and mortality in chronic renal failure patients.
- Uremia-related risk factors are key contributors to cardiac complications in these patients.
- Effective dialytic therapies are crucial for improving prognosis and survival.
Purpose of the Study:
- To assess the impact of dialysis adequacy on cardiac structure and function in children undergoing continuous ambulatory peritoneal dialysis (CAPD).
Main Methods:
- A cross-sectional study involving 18 pediatric CAPD patients and 20 healthy controls.
- Echocardiographic evaluations were performed on all participants.
- Dialysis adequacy was measured using weekly urea (Kt/V) and creatinine clearance (TCCr).
Main Results:
- CAPD patients exhibited significantly increased interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass index, and left ventricular dimensions compared to controls.
- No significant differences in ejection fraction or fractional shortening were observed between groups.
- Higher dialysis adequacy (Kt/V, TCCr) correlated with improved left ventricular dimensions and function, while elevated blood pressure correlated with increased left ventricular mass index.
Conclusions:
- Cardiac structure and function in pediatric CAPD patients are significantly affected by the uremic state and dialysis therapy.
- Adequate dialysis, indicated by higher Kt/V and TCCr, demonstrates a beneficial effect on cardiac function.
- Effective removal of uremic toxins through adequate dialysis is crucial for improving cardiac outcomes in pediatric CAPD patients.
Background:
Left ventricular hypertrophy is a major cause of morbidity and mortality among patients with chronic renal failure. Uremia-related risk factors play a fundamental role in its occurrence, thus better prognosis and prolonged survival can be attained by successful dialytic therapies.
Objective:
To investigate whether dialysis adequacy has a beneficial effect on cardiac structure and function in children receiving continuous ambulatory peritoneal dialysis (CAPD).
Design:
Cross-sectional study in the Pediatric Peritoneal Dialysis Unit of a university hospital.
Patients:
Eighteen children, aged 13.3 +/- 2.8 years, being treated with CAPD, and 20 healthy age- and sex-matched control subjects were enrolled in this study.
Main Outcome Measures:
Echocardiographic evaluation was performed in all subjects. Dialysis adequacy indices [weekly urea (Kt/V) and creatinine clearance (TCCr)] were calculated in the dialysis group.
Results:
Interventricular septal thickness, left ventricular (LV) posterior wall thickness, LV mass index (LVMI), and LV end systolic and diastolic dimensions were all found to be significantly higher in the CAPD group compared to the control subjects (p < 0.01). Ejection fraction and fractional shortening of the LV were not significantly different between the two groups. Mean Kt/V was 2.02 +/- 0.71 and mean TCCr was 58 +/- 33 L/wk/1.73 m2. There were significant negative correlations between dialysis adequacy indices and LV end systolic and diastolic dimensions (p < 0.05 and p < 0.001). Ejection fraction and fractional shortening were positively correlated with Kt/V (p < 0.01). Systolic and diastolic blood pressures were positively correlated with LVMI (r= 0.501 and r = 0.523). Significant inverse correlations between mean arterial pressure and both Kt/V and TCCr (r = -0.555 and r = -0.520) were detected.
Conclusion:
These data clearly document that cardiac structure and function are remarkably influenced by the uremic state and dialysis therapy in pediatric CAPD patients. The close relationships between echocardiographic findings and dialysis adequacy indices suggest that adequate dialysis has a beneficial effect on cardiac function via effective removal of toxic substances.