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Cardiac structure and function in continuous ambulatory peritoneal dialysis: influence of blood purification and
J Hüting1, W Kramer, J Reitinger
1Center of Internal Medicine, Justus-Liebig University, Federal Republic of Germany.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) patients show significant left atrial enlargement and asymmetric septal hypertrophy. These cardiac changes are linked to increased circulation and improved blood purification quality.
Area of Science:
- Nephrology
- Cardiology
- Medical Imaging
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) offers hemodynamic and blood purification benefits over intermittent hemodialysis.
- Left ventricular (LV) structure and function in CAPD patients require further investigation.
Purpose of the Study:
- To assess LV structure and function in normotensive patients undergoing CAPD.
- To identify factors associated with observed cardiac changes.
Main Methods:
- Echocardiography was used to analyze 55 normotensive CAPD patients (mean age 58.4 years).
- Measurements included LV hypertrophy, septal thickening, left atrial diameter, and systolic function parameters.
Main Results:
- Patients exhibited LV hypertrophy (158 +/- 50 gm/m2) and left atrial dilatation (40.9 +/- 7.4 mm).
- LV hypertrophy correlated with hypercirculation (cardiac index, hemoglobin) and blood purification quality (creatinine, urea).
- Left atrial dilatation was inversely related to LV systolic function and directly to LV muscle mass.
Conclusions:
- Normotensive CAPD patients frequently present with left atrial dilatation and asymmetric septal hypertrophy.
- These cardiac alterations are associated with hypercirculation and the effectiveness of blood purification.
Abstract:
Continuous ambulatory peritoneal dialysis (CAPD) is associated with obvious hemodynamic and blood purification advantages over intermittent hemodialysis. To determine whether this is reflected in favorable left ventricular (LV) structure and function, a group of 55 normotensive patients (aged 58.4 +/- 11.0 years) undergoing CAPD was analyzed by means of echocardiography. Characteristic findings were LV hypertrophy (158 +/- 50 gm/m2), mainly the result of septal thickening (13.3 +/- 2.8 mm), and left atrial dilatation (40.9 +/- 7.4 mm). Mean LV diameter in end diastole and end systole and posterior wall thickness were normal. Parameters of LV systolic function (ejection fraction [EF]: 62.0 +/- 13.0%; velocity of circumferential fiber shortening [Vcf]: 1.58 +/- 0.46 circ/sec) were in the upper normal range at a hyperdynamic circulatory state (cardiac index [CI] 4.67 +/- 1.82 L/min/m2. The amount of LV hypertrophy was related to the amount of hypercirculation (CI: p less than 0.001; hemoglobin: p less than 0.025) and quality of blood purification (creatinine, urea: p less than 0.02) but not to blood pressure, age, or duration of dialysis. Left atrial dilatation was inversely related to LV systolic function (EF, Vcf: p less than 0.001) and directly related to LV muscle mass (p less than 0.02). A low prevalence (13%) of pericardial effusion was independent of blood purification. We conclude that in normotensive patients receiving CAPD, a high prevalence of left atrial dilatation and asymmetric septal hypertrophy is found, the latter being related both to the amount of hypercirculation and the quality of blood purification.