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Abstract

Cardiovascular disease is commonly observed in patients with chronic renal failure and this is a leading cause of death in patients with end-stage renal disease undergoing maintenance dialysis. Myocardial energy production is a very crucial aspect of cardiac function. Therefore, to evaluate energy metabolism of myocardial muscle in peritoneal dialysis (PD) patients, we carried out the following study using Magnetic resonance spectroscopy (MRS). Fourteen chronic renal failure patients and eight healthy volunteers were enrolled. The ratio of the phosphocreatine peak to the beta-phosphate to ATP peak (PCr/beta-ATP) was calculated from their MR spectra obtained by 31P-MR spectroscopy (Gyroscan S15, Philips). To determine the correlation between cardiac function and energy status, the left atrial diameter, the left ventricular (LV) end-diastolic diameter, the ejection fraction, the fraction of shortening and the LV mass index were measured by echocardiography. Peripheral blood sampling was also performed for creatinine, blood urea nitrogen, hematocrit, hemoglobin, beta2-microglobuline, intact parathyroid hormone. PCr/beta-ATP was significantly lower in PD (1.03 +/- 0.15 vs. 1.40 +/- 0.18: p = 0.0002), although all patients showed normal systolic function. No correlation was found between PCr/beta-ATP and cardiac function or hematological or biochemical markers. A negative correlation was present between PCr/beta-ATP and dialysis duration (r = 0.57, p < 0.05). Altered energy status of the myocardium in PD should be considered even if the patients did not show any systolic dysfunction. 31P-MRS is a useful tool to evaluate the energy status of the myocardium.

Early cardiac dysfunction in pediatric patients on maintenance dialysis and post kidney transplant

“…This ratio is decreased in patients with chronic heart failure, ischemic heart disease, dilated cardiomyopathy, secondary myopathies, and muscular dystrophy [25]. Using cardiac 31P MRS, Ogimoto et al [26] performed a cross-sectional study of 14 adult patients (mean age 49.5±11.7 years) on peritoneal dialysis and eight healthy volunteers. They found the PCr/ATP ratio was significantly lower in the patient group, although all patients showed normal systolic function by echocardiography.…”

The creatine kinase system and pleiotropic effects of creatine

“…Patients with chronic renal failure (CRF) undergoing dialysis, who for obvious reasons are advised to restrict meat consumption, may present after a certain time with an altered skeletal and cardiac muscle energy metabolism, being low or deficient in Cr and showing a low PCr/ATP ratio (Pastoris et al 1997; Tagami et al 1998; Ogimoto et al 2003). It is known that these patients lose muscle mass, become weaker and experience chronic fatigue.…”

Chronic Dialysis Patients Are Depleted of Creatine: Review and Rationale for Intradialytic Creatine Supplementation

“…This is supported by the fact that skeletal muscle biopsies in CKD showed significantly low ATP and phosphocreatine levels [23]. This notion is further supported by studies showing lower phosphocreatine concentrations and a decreased phosphocreatine/ATP energy-charge ratio in the hearts and skeletal muscle of patients on either hemodialysis or peritoneal dialysis treatment, as shown by means of non-invasive in vivo 31P-NMR imaging [24][25][26].…”