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Continuous ambulatory peritoneal dialysis and the heart
M A Alpert1, J Hüting, Z J Twardowski
1Department of Internal Medicine, University of South Alabama, Mobile, U.S.A.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) can improve heart function and reduce left ventricular volume. While not arrhythmogenic, its impact on survival in heart failure patients and lipid abnormalities requires further study.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a renal replacement therapy with potential cardiovascular implications.
- Existing research has explored the relationship between CAPD and various cardiac parameters, including left ventricular structure and function.
Purpose of the Study:
- To comprehensively review existing clinical research on the effects of CAPD on the heart.
- To identify knowledge gaps regarding CAPD's impact on specific cardiac conditions.
Main Methods:
- A systematic literature search of Medline (1970-1994) was conducted.
- Keywords included CAPD, hemodialysis, heart, left ventricle, coronary artery disease, and survival.
- Forty-six relevant studies were reviewed and analyzed.
Main Results:
- CAPD demonstrated a capacity to decrease left ventricular volume and enhance systolic function in patients with LV enlargement or dysfunction.
- The effects of CAPD on left ventricular hypertrophy and diastolic function were variable.
- Coronary artery disease and congestive heart failure were identified as significant risk factors for survival in CAPD patients, though detailed quantification was limited.
- CAPD was found to be safe for patients undergoing coronary artery bypass surgery and was not associated with arrhythmias.
Conclusions:
- CAPD offers benefits for cardiac structure and function, particularly in patients with left ventricular issues.
- The clinical significance of atherogenic lipid abnormalities observed in CAPD patients remains uncertain.
- While CAPD can provide symptomatic relief for heart failure, its effect on survival in these patients is unclear.
- CAPD patient survival is comparable to hemodialysis, with a slight decrease noted only in elderly diabetics.
Objective:
To review clinical research pertaining to continuous ambulatory peritoneal dialysis (CAPD) and the heart.
Data Sources:
A Medline computer search was employed to identify appropriate references from 1970 - 1994. Indexing terms were: continuous ambulatory peritoneal dialysis, hemodialysis, heart or cardiac, left ventricle, coronary artery disease, and survival. English and non-English language abstracts were scrutinized.
Study Selection:
Forty-six studies were reviewed and utilized. Numerical data extracted are reported in this review as they were reported in the original article.
Results:
This review provides a broad-based survey of studies pertaining to CAPD and the heart. Most of the studies relate to CAPD and left ventricular structure or function. Little information exists concerning CAPD and coronary artery disease, valvular disease, pericardial disease, and cardiac arrhythmias. Studies pertaining to patient survival on CAPD identify coronary artery disease and congestive heart failure as major risk factors, but in-depth quantification of these cardiovascular disorders is lacking in the literature.
Conclusions:
CAPD is capable of decreasing left ventricular (LV) volume and improving LV systolic function in patients with LV enlargement and those with LV systolic dysfunction. The effect of CAPD on left ventricular hypertrophy (LVH) and LV diastolic function is variable. CAPD produces symptomatic improvement in patients with refractory congestive heart failure, but its effect on survival in such patients is uncertain. Atherogenic lipid abnormalities occur in CAPD patients. The clinical significance of these abnormalities is uncertain. Coronary artery bypass surgery can be performed safely and effectively on CAPD patients. CAPD is not arrhythmogenic. Survival of CAPD patients is similar to that of hemodialysis patients except in elderly diabetics for whom it is slightly lower.