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

Abstract

SummaryCardiovascular complications are the main cause of morbidity and mortality in peritoneal dialysis (PD) patients. Left ventricular hypertrophy (LVH) is a major predictor of the development of cardiovascular events. This study aimed to identify risk factors that contribute to the development of LVH and to determine their cutoffs in patients on maintenance peritoneal dialysis.In this cross sectional study we evaluated the association of 23 variables including age, PD vintage, ultrafiltration, urine volume, residual renal function, mean daily SBP, mean daily DBP, fasting glucose, HbA1c, peritoneal glucose load index (PGLI), fluid overload (FO), plasma brain natriuretic peptide (BNP), plasma hsCRP and IL-6, serum albumin, white blood cell (WBC) count, hemoglobin, hematocrit, triglycerides, LDL-C (low density lipoprotein cholesterol), HDL-C (high density lipoprotein cholesterol), and PTH with LVH in 38 stable patients on maintenance PD ≥ 24 months.LVH was detected in 57.9% of patients. Logistic regression and receiver operating characteristics (ROC) analysis revealed that HbA1c, PGLI, FO, plasma BNP, hsCRP and IL-6 seem to be possible predictors of LVH. The cutoffs associated with the presence of LVH were: 7.5%, 3.2 g/kg/day, 1.7 L, 330 pg/mL, 7.5 mg/dL and 3.3 pg/mL for HbA1c, PGLI, FO, plasma BNP, hsCRP and IL-6, respectively (sensitivity 72.8 to 81.8% and specificity 75.0 to 93.8%).The results suggest that efforts should be made to reduce the peritoneal glucose load (PGL), to improve the hydration status, and to attenuate the inflammatory process in order to reduce the risk of the development of LVH among PD patients. (Int Heart J 2015; 56: 186-191)

Residual Renal Function Affects Severity of Sleep Apnea in Peritoneal Dialysis: A Pilot Study

“…Other potential mechanisms connecting renal function to OSA relate to upper airway patency, which may be compromised in the setting of uremic myopathy [14, 15]. As more studies emerge linking decreased residual renal function to increased cardiovascular risk in ESRD and increased residual renal function to prolonged survival, this association with OSA is intriguing given that OSA has similarly been found to predict increased cardiovascular morbidity and mortality [16–18]. …”

Do Implantable Cardioverter Defibrillators Reduce Mortality in Patients With Chronic Kidney Disease at All Stages?

“…The mechanisms that underlie SCD in dialysis patients are complicated, and many factors have been suggested to explain the increased arrhythmic risk in patients on dialysis. Left ventricular hypertrophy, which is a common echocardiographic finding in dialysis patients, 39) has been linked to an increased risk of SCD as an arrhythmogenic substrate in CKD. Metabolic and electrolyte abnormalities, as well as fluid overload, may promote arrhythmias and increase the risk of SCD.…”

Associations of Peritoneal Glucose Load With Male Sexual Dysfunction and Depression in Peritoneal Dialysis Patients

“…For analysis, patients were categorized to two groups according to PGLI ≤3 g/kg per day and PGLI >3 g/kg per day. The cut‐off of 3 g/kg per day is based in our previous studies that evaluated the impact of PGLI on hydration status, inflammation and left ventricular mass in stable patients on maintenance PD . These studies demonstrated that hemoglobin A1c (HbA1c), fluid overload, plasma high sensitivity C‐reactive protein (hsCRP) and interleukin (IL)‐6 levels were significantly higher in patients with PGLI >3 g/kg per day compared with those with PGLI ≤3 g/kg per day ; PGLI was positively correlated with HbA1c and left ventricular mass index ( P < 0.001) and patients with PGLI >3 g/kg per day had higher HbA1c and left ventricular mass index compared to those with PGLI ≤3 g/kg per day ( P < 0.001) ; PGLI seemed to be possible predictor of left ventricular hypertrophy and its cutoff that was associated with the presence of LVH was 3.2 g/kg per day ; and finally, low peritoneal glucose load was associated with a protective effect from the development of left ventricular hypertrophy in PD patients .…”