BACKGROUND: The aim of this study was to evaluate whether diastolic dysfunction at the start of dialysis could influence renal and cardiovascular survival rates in 82 patients undergoing peritoneal dialysis. METHODS: Diastolic dysfunction was determined using left ventricular hypertrophy, the ratio of early peak transmitral inflow velocity to peak diastolic mitral annular velocity (E/E'), and left atrial volume index (LAVI). Residual renal function (RRF) was measured with 24-hour urine collections at baseline (within 1 month of beginning peritoneal dialysis) and thereafter at 6-month intervals for 2 years. To evaluate the long-term prognostic significance of diastolic dysfunction, the 4-year cardiac event-free survival was also evaluated. RESULTS: The median slope of RRF decline was -0.07 mL/min/mo/1.73 m(2). Forty-five patients (54.9%) with rapid RRF declines (< -0.07 mL/min/mo/1.73 m(2)) had a higher prevalence of diabetes and eccentric left ventricular hypertrophy, as well as significantly elevated E/E' ratios and LAVIs. There was a close relationship between baseline E/E' ratio (r = -0.221, P = .048), LAVI (r = -0.276, P = .015), and RRF decline rate, and both E/E' > 15 (odds ratio, 3.61; 95% confidence interval, 1.07-12.12) and LAVI > 32 mL/m(2) (odds ratio, 3.54; 95% confidence interval, 1.08-11.58) were significant independent predictors of the loss of RRF. Furthermore, E/E' > 15 also provided additional prognostic value in predicting future cardiac events (hazard ratio, 6.74; 95% confidence interval, 1.07-12.12; P = .023). CONCLUSIONS: Left ventricular diastolic dysfunction may be a significant predictor of rapid decline in RRF and adverse cardiac outcomes in patients starting peritoneal dialysis.
BACKGROUND: The aim of this study was to evaluate whether diastolic dysfunction at the start of dialysis could influence renal and cardiovascular survival rates in 82 patients undergoing peritoneal dialysis. METHODS:Diastolic dysfunction was determined using left ventricular hypertrophy, the ratio of early peak transmitral inflow velocity to peak diastolic mitral annular velocity (E/E'), and left atrial volume index (LAVI). Residual renal function (RRF) was measured with 24-hour urine collections at baseline (within 1 month of beginning peritoneal dialysis) and thereafter at 6-month intervals for 2 years. To evaluate the long-term prognostic significance of diastolic dysfunction, the 4-year cardiac event-free survival was also evaluated. RESULTS: The median slope of RRF decline was -0.07 mL/min/mo/1.73 m(2). Forty-five patients (54.9%) with rapid RRF declines (< -0.07 mL/min/mo/1.73 m(2)) had a higher prevalence of diabetes and eccentric left ventricular hypertrophy, as well as significantly elevated E/E' ratios and LAVIs. There was a close relationship between baseline E/E' ratio (r = -0.221, P = .048), LAVI (r = -0.276, P = .015), and RRF decline rate, and both E/E' > 15 (odds ratio, 3.61; 95% confidence interval, 1.07-12.12) and LAVI > 32 mL/m(2) (odds ratio, 3.54; 95% confidence interval, 1.08-11.58) were significant independent predictors of the loss of RRF. Furthermore, E/E' > 15 also provided additional prognostic value in predicting future cardiac events (hazard ratio, 6.74; 95% confidence interval, 1.07-12.12; P = .023). CONCLUSIONS:Left ventricular diastolic dysfunction may be a significant predictor of rapid decline in RRF and adverse cardiac outcomes in patients starting peritoneal dialysis.
Authors: Hyang Mo Koo; Fa Mee Doh; Chan Ho Kim; Mi Jung Lee; Eun Jin Kim; Jae Hyun Han; Ji Suk Han; Dong-Ryeol Ryu; Hyung Jung Oh; Jung Tak Park; Seung Hyeok Han; Tae-Hyun Yoo; Shin-Wook Kang Journal: Medicine (Baltimore) Date: 2015-02 Impact factor: 1.889
Authors: Jae Hyun Han; Ji Suk Han; Eun Jin Kim; Fa Mee Doh; Hyang Mo Koo; Chan Ho Kim; Mi Jung Lee; Hyung Jung Oh; Jung Tak Park; Seung Hyeok Han; Dong-Ryeol Ryu; Tae-Hyun Yoo; Shin-Wook Kang Journal: PLoS One Date: 2015-03-04 Impact factor: 3.240