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Left ventricular diastolic dysfunction in peritoneal dialysis: a forgotten risk factor.

Cho-Kai Wu1, Jen-Kuang Lee, Yi-Fan Wu

  • 1From the Division of Cardiology (C-KW, J-KL, C-TT, F-TC, J-JH, J-LL, J-WL), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital; Cardiovascular Center (C-KW, J-KL, C-TT, F-TC, J-JH, J-LL), National Taiwan University Hospital; Department of Family Medicine (Y-FW), Taipei City Hospital, Renai Branch; Division of Nephrology (K-YH, J-WH), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital; Department of Internal Medicine (J-WL), National Taiwan University College of Medicine and Hospital, Yun-Lin Branch, Yun-Lin, Taipei, Taiwan.

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Summary

Left ventricular diastolic dysfunction (LVDD) in peritoneal dialysis (PD) patients is linked to inflammation and visceral fat. LVDD independently predicts major adverse cardiovascular events (MACE) and mortality in PD patients.

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Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • Left ventricular diastolic dysfunction (LVDD) is prevalent in patients undergoing peritoneal dialysis (PD).
  • Understanding LVDD's impact on cardiovascular outcomes and mortality in PD patients is crucial.

Purpose of the Study:

  • To investigate the relationship between LVDD, major adverse cardiovascular events (MACE), and mortality in PD patients.
  • To explore the association of LVDD with systemic inflammation and visceral adipose tissue in PD patients.

Main Methods:

  • 149 PD patients with preserved systolic function were followed for 3.5 years.
  • LVDD diagnosed via echocardiography; serum high-sensitivity C-reactive protein (hsCRP) and visceral fat (CT scan) were measured.
  • Multivariate Cox regression analysis assessed LVDD and hsCRP as predictors of MACE and mortality.

Main Results:

  • LVDD patients exhibited higher hsCRP, visceral, and peritoneal fat.
  • LVDD was a significant, independent predictor of MACE (HR: 1.71) and mortality (HR: 2.25) in PD patients.
  • Systemic inflammation (hsCRP) also independently predicted MACE (HR: 2.03) and mortality (HR: 2.16).

Conclusions:

  • LVDD is associated with systemic inflammation and increased visceral fat in PD patients.
  • LVDD serves as a sensitive, independent indicator for predicting future MACE and mortality in PD patients.
  • Managing LVDD and inflammation is critical for improving cardiovascular outcomes in PD patients.