Document Detail

Disadvantage of long-term CAPD for preserving cardiac performance: an echocardiographic study.
MedLine Citation:
PMID:  9740166     Owner:  NLM     Status:  MEDLINE    
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.
K Takeda; M Nakamoto; H Hirakata; M Baba; M Kubo; M Fujishima
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  32     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  1998 Sep 
Date Detail:
Created Date:  1998-09-28     Completed Date:  1998-09-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  482-7     Citation Subset:  IM    
Kidney Center, Division of Internal Medicine, Saiseikai Yahata Hospital, Fukuoka, Japan.
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MeSH Terms
Blood Flow Velocity / physiology
Diabetic Nephropathies / physiopathology,  ultrasonography
Echocardiography, Doppler
Follow-Up Studies
Hemodynamics / physiology*
Hypertrophy, Left Ventricular / physiopathology,  ultrasonography*
Kidney Failure, Chronic / physiopathology,  ultrasonography*
Middle Aged
Peritoneal Dialysis, Continuous Ambulatory*
Renal Dialysis
Ventricular Function, Left / physiology

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