Cardiac geometry, function, and remodeling patterns in patients under maintenance hemodialysis and peritoneal dialysis treatment

Abstract

Cardiovascular disease is the leading cause of mortality in patients with end‐stage‐kidney disease. Evidence on the possible echocardiographic differences between hemodialysis and peritoneal dialysis (PD) is scarce. This study aimed to evaluate differences in left (LA) and right atrial (RA), left (LV) and right ventricular (RV) geometry, systolic and diastolic function in hemodialysis, and PD patients. Thirty‐eight hemodialysis and 38 PD patients were matched for age, sex, and dialysis vintage. Two‐dimensional and tissue‐Doppler echocardiography, and lung ultrasound were performed during an interdialytic day in hemodialysis and before a programmed follow‐up visit in PD patients. Vena cava diameter (11.09 ± 4.53 vs. 14.91 ± 4.30 mm; p < 0.001) was significantly lower in hemodialysis patients. Indices of LA, RA, LV, and RV dimensions were similar between the two groups. LVMi (116.91 [38.56] vs. 122.83 [52.33] g/m2; p = 0.767) was similar, but relative wall thickness was marginally (0.40 [0.14] vs. 0.45 [0.15] cm; p = 0.055) lower in hemodialysis patients. LV hypertrophy prevalence was similar between groups (73.7% vs. 71.1%; p = 0.798), but hemodialysis patients presented eccentric and PD patients concentric LVH. Regarding ventricular systolic function, stroke volume (p = 0.030) and cardiac output (p = 0.036) were higher in hemodialysis, while RV systolic pressure (RVSP) (20.37 [22.54] vs. 27.68 [14.32] mm Hg; p = 0.009) was higher in PD. No significant differences were evidenced in diastolic function indices and lung water excess between the two groups. A moderate association was noted between ultrasound B‐lines score and LA volume index (r = 0.465, p < 0.001), RVSP (r = 0.431, p < 0.001), and E/e′ ratio (r = 0.304, p = 0.009). Hemodialysis and PD patients present largely similar echocardiographic indices reflecting cardiac geometry, systolic, and diastolic function, but different patterns of abnormal LV remodeling.

Heart rate variability at rest and in response to stress: Comparative study between hemodialysis and peritoneal dialysis patients

“…36 Moreover, other studies showed similar levels of office and ambulatory pulse wave velocity between the two dialysis modalities, 37,38 suggesting no differences in arterial stiffness. Finally, as cardiac hypertrophy is considered to impact the cardiopulmonary reflex and chemosensitive receptors control, the largely similar cardiac geometry, systolic and diastolic function indices between HD and PD, 35 could also explain -at least in partour findings. As such, our findings are in general agreement with previous works that have evaluated other parameters related to sympathetic versus parasympathetic balance.…”

“…Factors like total small solute clearance, volume overload, blood pressure (BP) control, subclinical inflammation, anemia prevalence, and others were commonly found to be no different between HD and PD patients. 19,32–35 Elegant studies examining vascular function also suggest that these parameters were similar between HD and PD. In a recent study of our group, including 38 HD patients, 38 PD patients, and 38 controls, endothelial postocclusive forearm skin vasodilatory response assessed with laser speckle contrast imaging (an index of endothelial dysfunction) did not differ between HD and PD patients but was significantly impaired in both ESKD groups compared with controls.…”

Left Heart Failure Caused by Capacity Overload in Peritoneal Dialysis Patients

“…Most patients who receive dialysis develop anemia. Some scholars have reported that left ventricular mass index and Hb are negatively correlated in peritoneal dialysis patients [ 21 ]. In anemia, the number of red blood cells decreases, which can trigger a decrease in blood viscosity.…”

Volume markers in left ventricular diastolic dysfunction and adverse outcomes in peritoneal dialysis patients: a prospective cohort study

“…A continuous decrease in the E/E′ ratio was observed in patients undergoing dialysis. Nevertheless, a previous study showed no significant difference in E/E′ between patients on HD versus PD 24 . A study of patients with PD followed them for 3 years to determine the dynamic changes in LV structure and function.…”