Left Ventricular Hypertrophy and Blood Pressure Control in Automated and Continuous Ambulatory Peritoneal Dialysis Patients

Abstract

Hypertension, non-dipper blood pressure (BP) pattern and decrease in daily urine output have been associated with left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients. However, there is lack of data regarding the impact of different PD regimens on these factors. We aimed to investigate the impact of circadian rhythm of BP on LVH in end-stage renal disease patients using automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD) modalities. Twenty APD (7 men, 13 women) and 28 CAPD (16 men, 12 women) patients were included into the study. 24-h ambulatory blood pressure monitoring (ABPM) and transthoracic echocardiography besides routine blood examinations were performed. Two groups were compared with each other for ABPM measurements, BP loads, dipping patterns, left ventricular mass index (LVMI) and daily urine output. Mean systolic and diastolic BP measurements, BP loads, LVMI, residual renal function (RRF) and percentage of non-dippers were found to be similar for the two groups. There were positive correlations of LVMI with BP measurements and BP loads. LVMI was found to be significantly higher in diastolic non-dippers compared to dippers (140.4 ± 35.3 vs 114.5 ± 29.7, respectively, P = 0.02). RRF and BP were found to be independent predictors of LVMI. Non-dipping BP pattern was a frequent finding among all PD patients without an inter-group difference. Additionally, higher BP measurements, decrease in daily urine output and non-dipper diastolic BP pattern were associated with LVMI. In order to avoid LVH, besides correction of anemia and volume control, circadian BP variability and diastolic dipping should also be taken into consideration in PD patients.

The influence of low calcium dialysate on left ventricular diastolic function in peritoneal dialysis patients

“…Kim et al found that more than 80% ESRD patients had diastolic dysfunction, which might induce insufficiency of renal perfusion and lead to the decreasing of RRF. 6 In this study, we noticed low calcium dialysate preserved RRF by maintaining LV diastolic function. Studies have showed that RRF had beneficial effects on LV hypertrophy and fluid removal.…”

“…5 The decline of RRF induced extracellular fluid volume overload and hypertension, which resulted in myocardial hypertrophy. 6 However, the relationship of low calcium dialysate and LV diastolic function has not been fully clear until now. In this study, we recruited 60 PD patients and followed up for 12 months, aimed to illuminate the influence of low calcium dialysate on cardiac function in PD patients.…”

Predictors of Left Ventricular Hypertrophy and Their Cutoffs in Peritoneal Dialysis Patients

“…Recently, Atas, et al reported that a decrease in daily urine volume in PD patients on maintenance APD was associated with LVH. 9) In the current study, LVH was detected in 57.9% of patients and the LVMI was negatively correlated with daily urine volume (r = -0.41, P = 0.03). Recently, Inal, et al reported similar results: 58 percent of PD patients had LVH and the mean LVMI was negatively correlated with daily urine volume in PD patients (r = -0.568, P = 0.001).…”

“…8) High PGLI is usually accompanied by glucose absorption from the peritoneal cavity, resulting in harmful effects on glycemic control and lipid profile, and stimulation of the inflammatory process. [9][10][11] These effects appear to be associated with higher mortality. [9][10][11] Diabetes mellitus itself is a major CV risk factor in this population.…”

“…[9][10][11] These effects appear to be associated with higher mortality. [9][10][11] Diabetes mellitus itself is a major CV risk factor in this population.…”