CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS AND THE HEART

Objective: To review clinical research pertaining to continuous ambula tory peritoneal dialysis (CAPD) and the heart. Data Sources: A Medline computer search was employed to identify appropriate references from 1970 - 1994. indexing terms were: continuous ambulatory peritoneal dia lysis, hemodialysis, heart or cardiac, left ventricle, coronary artery disease, and survival. English and non-English language abstracts wer e scrutinized. Study Selection: Forty-six studies were reviewed and ut ilized. Numerical data extracted are reported in this review as they w ere reported in the original article. Results: This review provides a broad-based survey of studies pertaining to CAPD and the heart. Most o f the studies relate to CAPD and left ventricular structure or functio n. Little information exists concerning CAPD and coronary artery disea se, valvular disease, pericardial disease, and cardiac arrhythmias. St udies pertaining to patient survival on CAPD identify coronary artery disease and congestive heart failure as major risk factors, but in-dep th quantification of these cardiovascular disorders is lacking in the literature. Conclusions: CAPD is capable of decreasing left ventricula r (LV) volume and improving LV systolic function in patients with LV e nlargement and those with LV systolic dysfunction. The effect of CAPD on left ventricular hypertrophy (LVH) and LV diastolic function is var iable. CAPD produces symptomatic improvement in patients with refracto ry congestive heart failure, but its effect on survival in such patien ts is uncertain. Atherogenic lipid abnormalities occur in CAPD patient s. The clinical significance of these abnormalities is uncertain. Coro nary artery bypass surgery can be performed safely and effectively on CAPD patients. CAPD is not arrhythmogenic. Survival of CAPD patients i s similar to that of hemodialysis patients except in elderly diabetics for whom it is slightly lower.