Document Detail


Peritoneal dialysis is not associated with myocardial stunning.
MedLine Citation:
PMID:  20522673     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Hemodynamic changes during hemodialysis can precipitate subclinical myocardial ischemia, which over time contributes to the development of cardiac failure and is associated with a poor prognosis. Peritoneal dialysis (PD) is also associated with acute changes in systemic hemodynamics and a similarly high incidence of cardiovascular disease; we therefore sought to examine whether the hemodynamic effects of a PD exchange would be sufficient to induce subclinical myocardial ischemia.
METHODS: 10 patients on PD entered a prospective observational study to determine whether left ventricular (LV) regional wall motion abnormalities (RWMAs) developed following a dialysate exchange. Serial echocardiography with quantitative analysis was used to assess ejection fraction and regional systolic LV function (shortening fraction). Blood pressure (BP) and hemodynamic variables were measured using continuous pulse wave analysis.
RESULTS: We observed a very low frequency of RWMA development (5/100 regions). Only 1 patient had more than 1 RWMA and 6 patients were entirely unaffected. Overall mean shortening fraction increased when comparing pre and post values for both 2-chamber (from 3.06% ± 1.5% to 4.26% ± 1.3%, p = 0.001) and 4-chamber (from 3.00% ± 0.7% to 3.67% ± 0.9%, p = 0.021) analyses. Mean arterial pressure fell by a small degree during drainage of dialysate, with a larger rise in BP observed during instillation. These changes were driven by changes in peripheral resistance that fell during drainage and rose during instillation.
CONCLUSIONS: In contrast to hemodialysis, the acute effects of PD do not result in subclinical myocardial ischemia.
Authors:
Nicholas M Selby; Christopher W McIntyre
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Publication Detail:
Type:  Journal Article     Date:  2010-06-03
Journal Detail:
Title:  Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis     Volume:  31     ISSN:  1718-4304     ISO Abbreviation:  Perit Dial Int     Publication Date:    2011 Jan-Feb
Date Detail:
Created Date:  2011-02-01     Completed Date:  2011-12-30     Revised Date:  2012-08-08    
Medline Journal Info:
Nlm Unique ID:  8904033     Medline TA:  Perit Dial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  27-33     Citation Subset:  IM    
Affiliation:
Department of Renal Medicine, Royal Derby Hospital, Derby, UK. nick.selby@nhs.net
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Female
Hemodynamics
Humans
Male
Middle Aged
Myocardial Stunning / etiology*
Peritoneal Dialysis, Continuous Ambulatory / adverse effects*
Prospective Studies
Ventricular Dysfunction, Left / etiology
Comments/Corrections
Comment In:
Perit Dial Int. 2011 Mar-Apr;31(2):135-7   [PMID:  21427246 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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