Peritoneal Dialysis as Compared with Hemodialysis Is Associated with Higher Overhydration but Non-Inferior Blood Pressure Control and Heart Function

Yao, Yen Hung; Fu, Chun Hsiang; Ho, Shuenn Jiin; Tsai, Shin Hung; Ng, Yee Yung; Chuang, Chiao Lin; Lin, Chih Chin; Chen, Jinn Yang

doi:10.1159/000338964

Cited by 12 publications

(13 citation statements)

References 68 publications

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“…We therefore speculated that dialysis therapy could partly decrease intraventricular energy loss, but cardiac structural diseases such as LV hypertrophy and myocardial fibrosis still contributed to the abnormally increased energy loss value; the unrelieved ventricular workload would create a feedback loop with the impaired LV mass index, which might help explain why long‐term dialysis therapy has no benefits for cardiac function, 23 and renal transplantation is not associated with substantial regression of the LV mass index in some patients with ESRD 24 . Although peritoneal dialysis treatment is characterized by continuous ultrafiltration, with better hemodynamic stability, 25 Yao et al 26 demonstrated that no difference in cardiac function was found between patients receiving peritoneal dialysis and hemodialysis. In our study, the patients receiving peritoneal dialysis had no significantly different degree of intraventricular dissipative energy loss compared to the patients receiving hemodialysis, and they had a similar regulated blood pressure level and LV mass index.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Left Ventricular Dissipative Energy Loss by Vector Flow Mapping in Patients With End‐Stage Renal Disease

Zhong

Liu

et al. 2016

J of Ultrasound Medicine

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Objectives Dissipative energy loss derived from vector flow mapping represents the viscous dissipation of turbulent blood flow. We aimed to determine the left ventricular (LV) energy loss in patients with end‐stage renal disease (ESRD). Methods Patients with ESRD and a preserved LV ejection fraction, who consisted of a group receiving peritoneal dialysis, a group receiving hemodialysis, and a group receiving preparation for dialysis initiation, were examined by echocardiography; a group of healthy control participants were examined as well. Vector flow mapping analysis was then performed from the apical 4‐chamber view to calculate the energy loss during diastole and systole in the left ventricle. Results Conventional transthoracic echocardiography and LV energy loss calculations were successfully performed in 63 cases and 50 controls. The patients with ESRD had significantly higher diastolic energy loss [median (interquartile range), 71.73 (46.08–106.75) versus 23.32 (17.17–29.26) mW/m; P < .001] and higher systolic energy loss [25.28 (19.03–33.93) versus 12.52 (9.35–16.47) mW/m; P < .001]. A significant difference in diastolic energy loss between the peritoneal dialysis and preparation groups was found [54.92 (39.28–89.94) versus 84.82 (62.58–171.4) mW/m; P = .04]. In patients with ESRD, the log‐transformed diastolic energy loss had a significant association with the peak early diastolic transmitral flow velocity (P = .011), peak early diastolic transmitral flow velocity–to–peak early diastolic mitral annular flow velocity ratio (P = .001), LV mass index (P = .017), and heart rate (P = .003). Conclusions Impaired blood flow efficiency was detected in patients with ESRD by using dissipative energy loss derived from vector flow mapping. The energy loss value could be a novel parameter for evaluating the ventricular workload of uremic hearts in terms of fluid mechanics.

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Section: Discussionmentioning

confidence: 99%

Assessment of Left Ventricular Dissipative Energy Loss by Vector Flow Mapping in Patients With End‐Stage Renal Disease

Zhong

Liu

et al. 2016

J of Ultrasound Medicine

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“…The study by Yao et al compared the hydration state of 75 HD and 94 PD recipients in Taiwan using BIA in terms of mortality, blood pressure and cardiac function [ 24 ]. The analyzed PD group was, similarly to ours, younger and with less comorbidity.…”

Section: Discussionmentioning

confidence: 99%

“…Their results are inconsistent with the considerably higher mean OH on HD found in our study. Nutritional state markers, dialysis vintage and mortality were not included in their analyses [ 24 ]. Other studies based on the use of different BIA tools and methodology also suggested more substantial OH affecting patients on PD [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Dialysis vintage stratified comparison of body composition, hydration and nutritional state in peritoneal dialysis and hemodialysis patients

Hoppe¹,

Schwermer²,

Kawka³

et al. 2016

aoms

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IntroductionBody mass decomposition and hydration state imbalances affect patients on maintenance dialysis. We compared body composition, hydration and nutritional state of patients on peritoneal dialysis (PD) and hemodialysis (HD) based on dialysis vintage (DV).Material and methodsThree hundred and fifty-nine prevalent patients on HD (n = 301) and PD (n = 58) were divided into 3 subgroups depending on DV: < 2 years HD (n = 41) and PD (n = 28), 2–4 years HD (n = 111) and PD (n = 17), > 4 years HD (n = 149) and PD (n = 13). Bioimpedance analysis delivered data including overhydration (OH), Lean (LTM) and adipose lipids mass (FAT). Other measurements included daily diuresis (DD), subjective global assessment (SGA) and serum albumin (alb), C-reactive protein (CRP) and total cholesterol (TChol), and hemoglobin (Hb).ResultsDialysis vintage < 2 years. Hemodialysis patients were older (65.5 ±18.5 vs. 50.9 ±17.1; p < 0.01) with a higher mortality (28 vs. 1; p < 0.01) and OH (8.0 ±4.3 vs. 1.6 ±3.1; p < 0.001). Hemoglobin (10.6 ±1.5 vs. 11.8 ±1.7; p < 0.05), TChol (180.2 ±47.0 vs. 211.7 ±46.3; p < 0.05), DD (871 ±729 vs. 1695 ±960; p < 0.001) and LTM (46.5 ±12.9 vs. 53.8 ±14.4; p < 0.05) were lower on HD. Dialysis vintage 2–4 years: when compared to PD, HD patients had higher OH (11.7 ±5.9 vs. 2.1 ±3.2; p < 0.001) and lower Hb (10.8 ±1.5 vs. 11.9 ±1.4; p < 0.01). Dialysis vintage > 4 years: compared to PD, HD patients had higher LTM (44.3 ±11.7 vs. 38.6 ±7.9; p < 0.05) and lower FAT (34.4 ±11.1 vs. 42.8 ±6.4; p < 0.01).ConclusionsDialysis patients’ body composition depends on dialysis modality and DV. Dialysis vintage < 2 years is associated with better hydration, nutritional state, and survival in PD patients, but longer DV reduces these benefits. Dialysis vintage > 4 years associated with similar hydration and mortality in both PD and HD while body composition was better on HD.

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“…The Netherlands Cooperative Study on the Adequacy of Dialysis showed that systolic BP (SBP) is an independent predictor of mortality and an indicator of fluid overload in dialysis patients. In particular, two specific causes of hypertension are often present: increased arterial stiffness and fluid overload [8,9,10,11]. Hypertension and hypervolemia can result in an increase in the left ventricular (LV) afterload and may lead to an increase in LV wall thickness, although this condition alone fails to explain LV hypertrophy (LVH).…”

Section: Introductionmentioning

confidence: 99%

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

Lai

Molfino

Russo³

et al. 2014

Cardiorenal Med

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Introduction: Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients. Materials and Methods: 45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH)andarterial blood gas analysis were also evaluated. Results: LVMI was higher in PD than HD patients (139 ± 19 vs. 104 ± 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined. Conclusions: Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored. © 2014 S. Karger AG, Basel

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Peritoneal Dialysis as Compared with Hemodialysis Is Associated with Higher Overhydration but Non-Inferior Blood Pressure Control and Heart Function

Cited by 12 publications

References 68 publications

Assessment of Left Ventricular Dissipative Energy Loss by Vector Flow Mapping in Patients With End‐Stage Renal Disease

Assessment of Left Ventricular Dissipative Energy Loss by Vector Flow Mapping in Patients With End‐Stage Renal Disease

Dialysis vintage stratified comparison of body composition, hydration and nutritional state in peritoneal dialysis and hemodialysis patients

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

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