CARDIAC FUNCTION AND STRUCTURE IN LONGITUDINAL ANALYSIS OF ECHOCARDIOGRAPHY IN PERITONEAL DIALYSIS PATIENTS

• Published in: Peritoneal dialysis international Vol. 30; no. 3; pp. 353 - 361
• Main Authors: IO, Hiroaki, RO, Yuuki, MASUDA, Atsumi, KANEKO, Kayo, HAMADA, Chieko, OHTAKI, Eiji, HORIKOSHI, Satoshi, TOMINO, Yasuhiko, SEKIGUCHI, Yoshimi, SHIMAOKA, Tetsutaro, INUMA, Jiro, HOTTA, Yoko, ARUGA, Seiki, INAMI, Yuko, SATO, Michiko, KOBAYASHI, Takashi
• Format: Journal Article
• Language: English
• Published: Milton, ON Multimed Inc 01.05.2010; Multimed
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atrial Function, Left; Atrial Natriuretic Factor - blood; Biological and medical sciences; Echocardiography; Echocardiography, Doppler, Color; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerulonephritis; Heart Atria - diagnostic imaging; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Peritoneal Dialysis; Ventricular Function, Left; Kidney disease; Human; Atrium; left ventricular mass index (LVMI); Urinary system disease; Echocardiography; Atrial natriuretic peptide; left atrium (LA) size; Peritoneal dialysis; Left ventricle; Extrarenal dialysis; Renal failure; atrial natriuretic peptide (ANP)
• ISSN: 0896-8608; 1718-4304
• DOI: 10.3747/pdi.2009.00007

Echocardiography is widely used for the evaluation of cardiac structures and function. The prognostic value of assessment of left cardiac atrium (LA) size in peritoneal dialysis (PD) patients is still unclear. The objective of the present study is to investigate prospectively a longitudinal monitoring of echocardiography parameters after start of PD. We also investigated a correlation study among plasma atrial natriuretic peptide (ANP) level, LA size, and cardiac function undergoing aggressive treatment. Correlation among plasma ANP, LA size, and cardiac function was prospectively analyzed by Doppler echocardiography in 32 PD patients in Juntendo University Hospital, Tokyo. Measurement of these parameters was performed at 0, 6, 12, 18, and 24 months after start of PD. All patients were treated with an angiotensin type 1 receptor blocker to control blood pressure to less than 140/90 mmHg. Other antihypertensive drugs such as diuretics and/or calcium channel blockers were added if blood pressure rose to over 140/90 mmHg. Hemoglobin and hematocrit levels were targeted at 10.0 g/dL and 30.0% respectively with recombinant human erythropoietin treatment. A diuretic was added or patients decreased their water intake if ANP was more than 43.0 pg/mL or LA diameter (LAD) more than 39 mm, and for other basic markers of volume status. Cardiac function was measured before and after drainage of PD fluid to evaluate the influence of cardiac function. LAD at start of dialysis (36 +/- 4.6 mm) decreased significantly to 33 +/- 3.3 mm (p < 0.05), 33 +/- 3.2 mm (p < 0.05), and 33 +/- 3.6 mm (p < 0.05) after 6, 12, and 24 months, respectively. Ejection fraction after 6 months was significantly increased compared with that at start of dialysis (p < 0.05). Left ventricular mass index (LVMI) after 6, 12, and 24 months was significantly decreased compared with that at start of dialysis (p < 0.05). ANP was 56 +/- 39 pg/mL at start of dialysis and decreased significantly to 33 +/- 19 pg/mL after 24 months (p < 0.05). ANP was significantly correlated with LAD (r = 0.412, p < 0.01), transmitral A wave flow velocity (r = 0.429, p < 0.01), and LVMI (r = 0.426, p < 0.01). Instillation of the dialysis fluid did not affect any parameters except inferior vena cava dimension. This study demonstrates a reduction in LA size and LVMI in PD patients followed over 24 months. Left ventricular structure, contraction, and compliance were well preserved in PD patients undergoing aggressive treatment based on measurements of plasma ANP and LAD.