Heart Failure With Preserved or Reduced Ejection Fraction in Patients Treated With Peritoneal Dialysis

• Published in: American journal of kidney diseases Vol. 61; no. 6; pp. 975 - 983
• Main Authors: Wang, Angela Yee-Moon, MD, PhD, FRCP, Wang, Mei, PhD, Lam, Christopher Wai-Kei, FACB, PhD, Chan, Iris Hiu-Shuen, PhD, Lui, Siu-Fai, FRCP, Sanderson, John E., MD, FRCP
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2013; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; cardiovascular outcomes; Cohort Studies; Female; Heart; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - etiology; Heart Failure - physiopathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hong Kong; Humans; Kidney Failure, Chronic - complications; Longitudinal Studies; Male; Medical sciences; Middle Aged; mortality; Nephrology; Nephrology. Urinary tract diseases; peritoneal dialysis; Peritoneal Dialysis - adverse effects; preserved ejection fraction; Prospective Studies; Stroke Volume - physiology; Ultrasonography; Heart failure; preserved ejection fraction; mortality; peritoneal dialysis; cardiovascular outcomes; Human; Nephrology; Prognosis; Mortality; Cardiovascular disease; Epidemiology; Peritoneal dialysis; Urology; Extrarenal dialysis; Treatment; Heart disease; Circulatory system; Hemodynamics; Ejection fraction
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2012.12.030

Background Heart failure is one of the most frequent complications in dialysis patients. However, little is known of the significance of the entity “heart failure with preserved ejection fraction” (HFPEF) in this population. This study aimed to determine the prevalence, clinical profiles, and long-term outcomes of peritoneal dialysis patients with HFPEF. Study Design Prospective cohort study. Setting & Participants 220 patients treated with peritoneal dialysis were recruited from a university teaching hospital in Hong Kong. Predictor Heart failure was defined clinically based on the presence of: (1) symptoms and signs, including dyspnea, increased jugular venous pressure, and basal crepitations; (2) radiographic evidence of pulmonary venous congestion or interstitial edema; and (3) resolution of symptoms, signs, and radiographic changes with hypertonic peritoneal dialysis exchanges. Based on a combination of clinical history of heart failure and echocardiography-derived ejection fraction, patients were classified as having no heart failure, HFPEF, and heart failure with reduced ejection fraction (HFREF). Outcomes All-cause mortality, cardiac death, heart failure, and fatal or nonfatal cardiovascular events. Measurements All patients underwent 2-dimensional echocardiography and tissue Doppler imaging at baseline and were followed up prospectively for clinical events for 4 years. Results 86 (39%) patients had heart failure, of whom 54.7% had preserved ejection fraction ≥50% and 45.3% had reduced ejection fraction <50%. Patients with HFPEF were intermediate between those with no heart failure and those with HFREF in terms of blood pressure, prevalence of coronary artery disease, diabetes, cardiac biomarkers, left ventricular mass, volume, and ratio of early mitral inflow velocity to peak mitral annulus velocity. In the multivariable Cox regression analysis, patients with HFPEF showed an increased adjusted HR for cardiac death (2.57; 95% CI, 1.20-5.50), heart failure (HR, 2.25; 95% CI, 1.28-3.96), and fatal or nonfatal cardiovascular event (HR, 2.01; 95% CI, 1.26-3.21) compared with those with no heart failure, but the risk was lower compared with those with HFREF. Limitations The study included prevalent peritoneal dialysis patients and may introduce survival bias. Conclusions HFPEF is common in peritoneal dialysis patients (∼55% of all heart failure) and is associated with increased risk of mortality and adverse cardiovascular outcomes compared with those with no heart failure, although the risk was lower than in patients with HFREF. This entity needs to be more recognized in peritoneal dialysis patients.