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Disadvantage of long-term CAPD for preserving cardiac performance: an echocardiographic study
K Takeda1, M Nakamoto, H Hirakata
1Kidney Center, Division of Internal Medicine, Saiseikai Yahata Hospital, Fukuoka, Japan.
Insights
Long-term continuous ambulatory peritoneal dialysis (CAPD) patients show impaired cardiac function, particularly after five years. This cardiac dysfunction in CAPD patients is linked to hypervolemia and glucose loading, suggesting it
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Chronic kidney disease patients often experience cardiovascular complications.
- Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) are common renal replacement therapies.
- Long-term dialysis can impact cardiac performance and structure.
Purpose of the Study:
- To compare cardiac performance indices between CAPD and HD patients.
- To investigate the effects of dialysis duration on cardiac function.
- To identify factors contributing to cardiac dysfunction in long-term dialysis patients.
Main Methods:
- Echocardiography and pulsed Doppler were used to assess cardiac performance.
- Patients were categorized into long-term CAPD (L-CAPD), short-term CAPD (S-CAPD), and HD groups.
- Diabetic HD patients (DM-HD) and a healthy control group were included for comparison.
Main Results:
- L-CAPD patients exhibited higher blood pressure and cardiothoracic ratio.
- Left ventricular mass index (LVMI) and peak atrial filling velocity were highest in L-CAPD.
- Left ventricular fractional shortening (%FS) was lowest in L-CAPD, similar to DM-HD patients.
Conclusions:
- Long-term CAPD (over 5 years) is disadvantageous for cardiac function compared to HD.
- Hypervolemia and glucose loading in CAPD may lead to cardiac preload and incipient heart failure.
- Hypertension, hyperlipidemia, and chronic glucose exposure contribute to LV hypertrophy and dysfunction in long-term CAPD.
Abstract:
The indices of cardiac performances were compared between 31 continuous ambulatory peritoneal dialysis (CAPD) and 20 long-term hemodialysis (HD) patients. They were subdivided into three groups according to dialysis duration: L-CAPD (n = 16, mean age and CAPD duration were, respectively, 53 +/- 8 [SD] years and 77 +/- 13 months); S-CAPD (n = 15; 52 +/- 12 years, 28 +/- 12 months); HD (n = 20; 51 +/- 10 years, 162 +/- 52 months). The diabetic HD patients (DM-HD; n = 13; 60 +/- 13 years of age, 22 +/- 11 months) were chosen separately. Thirteen normotensive subjects with normal kidney function (mean age, 57 +/- 9 years) were selected as an age-matched control group. There were no significant differences between groups in age, gender, incidence of original kidney disease, or serum biochemical data. The blood pressure and the cardiothoracic ratio in L-CAPD were highest among groups. The indices of left ventricular (LV) hypertrophy as well as LV performance by means of echocardiography or pulsed Doppler were compared. Among nondiabetic dialysis patients, the calculated LV mass index (LVMI) of 166.4 +/- 84.3 g/m2 and the ratio of the peak atrial filling velocity to the peak diastolic flow velocity of 1.25 +/- 0.4 in L-CAPD were greatest, and the left ventricular fractional shortening (%FS) of 34.2 +/- 10.8% in L-CAPD was smallest. LVMI or %FS of L-CAPD was the same as DM-HD of 161.0 +/- 40.7 g/m2 or 31.6 +/- 8.2%. Possibly, poor control of hypervolemia, which is caused by peritoneal problems induced by either peritonitis or chronic exposure to high-glucose dialysate, causes a substantial cardiac preload leading to incipient cardiac failure in L-CAPD. According to the similar results of L-CAPD and DM-HD, it may be that hypertension, hyperlipidemia, or long-term constant glucose loading of CAPD fluids in addition to impaired glucose tolerance by chronic renal failure is more or less related to the progression of LV hypertrophy and latent cardiac dysfunction in long-term CAPD patients. In this context, CAPD of more than 5 years' duration is disadvantageous for preserving cardiac function as compared with HD.