Abstract
BackgroundThis study aimed to evaluate the longitudinal changes in cardiac structure and function in incident-automated peritoneal dialysis (APD) patients.MethodsWe conducted a 2-year prospective, randomized, open-label, parallel-group study to compare the efficacy of icodextrin solution versus glucose-based solution. Echocardiography was performed at baseline, 1 and 2 years. Echocardiographic parameters over 2 years were evaluated for each group, using the Friedman test. Generalized linear regression analysis was used to test the associations between baseline clinical variables and echocardiographic changes, and a multivariate model was used to analyze cardiac function between the two groups.ResultsA total of 43 APD patients were enrolled in the beginning of this study. Twenty patients in the icodextrin group (ICO) and 18 patients in the glucose group (GLU) completed the study. In left ventricular (LV) systolic function measurements, ejection fraction (EF) increased significantly in the GLU group. Measurements of LV diastolic function and septal early mitral annulus velocity (EMV) increased significantly from baseline to 24-months in the ICO group (5.43–5.51 ms). The GLU group showed a significant decrease in peak early diastolic velocity (EDV) (70.67–68.25 cm/s), but a significant increase in septal EMV (5.94–7.57 ms) from baseline to 24-months. No significant association was found between the baseline clinical variables and echocardiographic changes within 24 months in the generalized linear regression analysis. Multivariate models were used to investigate changes in the four primary endpoints, namely, myocardial performance index (MPI), left ventricular ejection fraction (LVEF), deceleration time (DT), and E/e′ ratio. These primary endpoints show no significant association with the baseline values in both the ICO and GLU groups.ConclusionThe present study demonstrates that long-dwell icodextrin solution can maintain reasonable cardiac structure and function in incident-APD patients.Trial registrationISRCTN14931270 (retrospectively registered on 23/03/2018).
Highlights
This study aimed to evaluate the longitudinal changes in cardiac structure and function in incidentautomated peritoneal dialysis (APD) patients
A prior study revealed that chronic kidney disease (CKD) patients exhibited increased left ventricular (LV) mass index, left atrial volume index, and diastolic dysfunction, with their status deteriorating with the progression of CKD [4]
Another study investigated cardiac function in predialysis CKD patients, and revealed diastolic dysfunction indicated by an increase in the ratio of mitral inflow velocity and mitral annulus velocity, and left atrial volume indexed for height, prior to dialysis initiation [3]
Summary
This study aimed to evaluate the longitudinal changes in cardiac structure and function in incidentautomated peritoneal dialysis (APD) patients. Among the clinical manifestations of patients with CKD, heart failure is the most prevalent. A prior study revealed that CKD patients exhibited increased left ventricular (LV) mass index, left atrial volume index, and diastolic dysfunction, with their status deteriorating with the progression of CKD [4]. Another study investigated cardiac function in predialysis CKD patients, and revealed diastolic dysfunction indicated by an increase in the ratio of mitral inflow velocity and mitral annulus velocity, and left atrial volume indexed for height, prior to dialysis initiation [3]. A previous study demonstrated that, among prevalent peritoneal dialysis (PD) patients, those without a history of heart failure had an increased ratio of mitral inflow velocity and mitral annulus velocity, and that deceleration time indicated diastolic dysfunction [5]. Evaluation of cardiac structure and function in CKD patients is crucial in long-term CKD management
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