FLUID OVERLOAD IMPACT ON BOTH ARTERIAL STIFFNESS AND DIASTOLIC HEART FAILURE IN PERITONEAL DIALYSIS PATIENTS

MELAHAT COBAN¹ , AYÇA INCI¹ , METIN SARIKAYA¹ , SULEYMAN DOLU¹ , ZEHRA ERKAL² , FUNDA SARI³ , RAMAZAN CETINKAYA³

¹ 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.