, AYÇA INCI1
, METIN SARIKAYA1
, SULEYMAN DOLU1
, ZEHRA ERKAL2
, FUNDA SARI3
, RAMAZAN CETINKAYA3
Antalya Training and Research Hospital, Nephrology Department - 2
Antalya Training and Research Hospital, Cardiology
Department - 3
Akdeniz University, Faculty of Medicine, Nephrology Department
Introduction: Chronic subclinical volume overload, frequently observed in peritoneal dialysis (PD) patients, is associated with
increased arterial stiffness (AS), diastolic heart failure (HF), and higher mortality and morbidity. Diastolic HF is also known as HF
with preserved left ventricular (LV) ejection fraction (LVEF). We here in evaluated the effect of volume status on development of arterial
stiffness and diastolic HF in patients with normal or near-normal LV systolic function.
Materials and methods: A total of 75 chronic patients with PD and 52 age- and gender-matched control subjects were included
in this study. Fluid overload (FO) was determined using multifrequency bioelectrical impedance analysis (mBIA). LVEF, peak
velocity of atrial filling (E/A ratio), left atrium diameter (LAD), LV end-diastolic diameter (LVEDD), and LV end-systolic diameter
(LVESD) were obtained using echocardiography (ECHO). Brachial-ankle artery pulse wave velocity (baPWV) and augmentation
index (AIx) were measured to determine AS.
Results: Of a total 75 patients, 56 (59.6%) were undergoing continuous ambulatory PD (CAPD). The mean values for systolic
blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and pulse pressure (PP) were 130 ± 24,
80 ± 17, 103 ± 19, and 50 ± 16 mmHg, respectively. The mean SBP, LAD, and LV mass index (LVMI) (all p < 0.005) were higher and
the E/A ratio (p = 0,000) was lower in patients with PD than in healthy controls. Comparison of hypervolemic and normovolemic
patients showed that the mean SBP, LAD, LVEDD, LVESD, and LVMI (all p < 0.005) were significantly higher and the mean LVEF
(p = 0.003) was significantly lower in the hypervolemic group, whereas the mean DBP, MAP, baPWV, PP, and AIx were not significantly
different between the two groups (all p > 0.005). Multivariate regression analysis adjusted for ECHO parameters revealed
that age (β = 0.733, p = 0.001), diabetes status (β = 0.184, p = 0.027), and SBP (β = 0.519, p = 0.001) were independently associated
with increased baPWV.
Conclusions: Overhydration (OH) was higher in patients with PD than in healthy controls and was associated with development
of diastolic HF in patients with PD. Additionally, age, SBP, and diabetes status and not FO were independent predictors of
baPWV in patients with PD.
bioimpedance analysis, brachial-ankle artery pulse wave velocity, diastolic heart failure, peritoneal dialysis