Continuous ambulatory peritoneal dialysis and the heart

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.