Heart Failure in Long-Term Peritoneal Dialysis Patients

Wang, Angela Yee-Moon; Wang, Mei; Lam, Christopher Wai Kei; Chan, Iris Hiu Shuen; Lui, Siu Fai; Sanderson, John E.

doi:10.2215/cjn.07130810

Cited by 54 publications

(46 citation statements)

References 31 publications

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“…Many studies have shown that diastolic dysfunction may ultimately be a risk factor for LV systolic dysfunction and future congestive heart failure [20]. We also found that none of our patients had congestive heart failure and all had normal systolic function despite increased LV mass index, though with a significantly better LV systolic function after 18 months of PD treatment.…”

Section: Discussionsupporting

confidence: 57%

Alteration of Cardiovascular Structure and Function in Patients Undergoing Peritoneal Dialysis

et al. 2015

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Aims: Cardiovascular alterations contribute to a high mortality rate in patients with end-stage renal disease (ESRD). The aims of the present study are to evaluate left ventricular (LV) function and common carotid artery (CCA) parameters and to determine risk factors associated with these changes in patients undergoing peritoneal dialysis (PD). Methods: This longitudinal prospective study was conducted in 50 ESRD patients in whom PD had been initiated and who were observed for 18 months after the commencement of dialysis treatment, with echocardiography and CCA ultrasound parameter evaluation. Results: LV hypertrophy was observed in 78% of patients at baseline and in 60% after 18 months of PD treatment. LV systolic and diastolic function was found to be significantly better after 18 months of PD treatment. Examining predictors of LV systolic function, it was found that total cholesterol was an independent positive predictor and endothelin-1 (ET-1) an independent negative predictor of LV systolic function after 18 months of treatment with PD (p < 0.001). Independent negative predictors of diastolic LV function were hemoglobin and type 2 diabetes mellitus, and daily collection of urine was an independent positive predictor (p < 0.001). Female gender was an independent negative predictor of CCA intima-media thickness, whereas body mass index, ET-1 and C-reactive protein were independent positive predictors (p < 0.001). Conclusions: The results suggest several novel modifiable mechanisms related to the short-term effects of dialysis that are potentially implicated in the development of uremic cardiomyopathy.

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Section: Discussionsupporting

confidence: 57%

Alteration of Cardiovascular Structure and Function in Patients Undergoing Peritoneal Dialysis

et al. 2015

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“…Heart failure (HF) is one of the most frequent cardiac complications in ESRD patients. Left ventricular (LV) systolic dysfunction, defined by low LV ejection fraction (LVEF), is associated with poor prognosis (2)(3)(4). However, abnormal LV functions, as recognized by conventional echocardiography, may identify only dialysis patients with established cardiovascular disease (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Liu¹,

Sung

et al. 2013

Clinical Journal of the American Society of Nephrology

101

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SummaryBackground and objectives Little is known about the optimal echocardiographic parameters for risk stratification in stable dialysis patients with preserved left ventricular ejection fraction (LVEF) (ejection fraction $50%). Left ventricular (LV) global peak systolic longitudinal strain (GLS) is the ratio of the maximal change in myocardial longitudinal length in systole to the original length and reliably and accurately assesses LV function. During systole, LV myocardium in the longitudinal direction shortens and GLS is represented by a negative value. The more negative value of GLS, the better the LV function is. This study hypothesized that subtle abnormalities of GLS are associated with an adverse prognosis.Design, setting, participants, & measurements This prospective study collected clinical and echocardiographic data (including GLS) from 88 stable hemodialysis patients (mean age 67.0611.2 years; 35% men) with preserved LVEF. These patients were enrolled from December 2008 to January 2009 and were followed-up for 25.669.9 months. The primary outcome was all-cause mortality. Multivariate Cox regression analysis was used to investigate risk factors for mortality.Results The mortality group (n=24) had lower albumin levels, less negative GLS, and higher prevalence of coronary artery disease and diabetes mellitus than the survival group. Using a GLS cutoff value of 215%, the less negative GLS group (GLS $215%) had a higher mortality rate. Cox regression analyses revealed that lower albumin level (hazard ratio, 0.16; 95% confidence interval, 0.05 to 0.53; P=0.003) and less negative GLS (hazard ratio, 3.57; 95% confidence interval, 1.41 to 9.04; P=0.01) were independent predictors of all-cause mortality. Furthermore, less negative GLS was associated with a higher cardiovascular death rate.Conclusions Less negative GLS is predictive of poor prognosis among stable hemodialysis patients with preserved LVEF.

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“…[2][3][4][5][6][7][8] But there are no clear-cut criteria for the diagnosis of hypovolemia or hypervolemia. Some patients have elevated systolic blood pressure, despite being euvolemic which is thought to be due to vascular stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…For both the treatment modalities, international guidelines underline volume status for dialysis adequacy. 1 One of the main factors determining the morbidity and mortality in PD patients is volume status [2][3][4][5][6][7] and may even be more important than solute clearance. 8 Besides clinical findings (blood pressure, presence of edema, and weight gain), echocardiography, Dual Energy X-ray Absorptiometry (DEXA), direct measurement of extracellular and total body water (TBW), brain natriuretic peptide (BNP) has been used for the determination of hydration status.…”

Section: Introductionmentioning

confidence: 99%

Volume Status in Patients on Peritoneal Dialysis: The Role of Apelin and Bio-Impedance Spectroscopy

et al. 2012

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One of the main factors determining the survival of peritoneal dialysis (PD) patients is volume status. We aimed to investigate hydration status of PD patients by bio-impedance spectroscopy (BIS) and echocardiography and to study the relation of them with apelin, which has effects related with volume status like vasodilation, positive inotropism, and inhibition of ADH release and RAS antagonism. Chronic PD patients without active cardiac disease or clinically prominent hypervolemia were included. Besides the demographic, clinical, and laboratory data, BIS and echocardiographic findings together with apelin levels were recorded. The study included 21 patients. Of them, eight patients were euvolemic, one patient was hypovolemic, and others have some degree of overhydration (1.1-6.8 L) with BIS, although all were euvolemic clinically. Mean apelin level was 1.49 AE 0.49 ng/mL. Apelin level was positively correlated with ejection fraction and negatively with total body water (TBW), intracellular and extracellular water, lean tissue mass, and left atrium diameter. On linear regression model, TBW was the major determinant of apelin. Although apelin is expected to increase in hypervolemic patients, the negative correlation with body water in this study may be related with yet unknown role of apelin in dialyzed patients. They may have important roles in volume status in future.

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Heart Failure in Long-Term Peritoneal Dialysis Patients

Cited by 54 publications

References 31 publications

Alteration of Cardiovascular Structure and Function in Patients Undergoing Peritoneal Dialysis

Alteration of Cardiovascular Structure and Function in Patients Undergoing Peritoneal Dialysis

Association of Left Ventricular Longitudinal Strain with Mortality among Stable Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

Volume Status in Patients on Peritoneal Dialysis: The Role of Apelin and Bio-Impedance Spectroscopy

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