ECHOCARDIOGRAPHIC EVALUATION IN LONG-TERM CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS COMPARED WITH THE HEMODIALYSIS-PATIENTS

In dialysis patients, the prevalence of severe left ventricular (LV) h ypertrophy and systolic failure, important predictors of cardiovascula r morbidity and mortality, has been reported to be very high, Therefor e, we investigated cardiac function in 17 long-term CAPD patients (dia lysis duration: 76.5 +/- 13.2 months; L-CAPD) by echocardiography and pulsed Doppler, and then compared with 16 short-term CAPD patients (di alysis duration: 28.9 +/- 11.9 months: S-CAPD), 21 long-term hemodialy sis patients (dialysis duration: 165.1 +/- 52.7 months; L-HD), and 22 short-term hemodialysis patients (dialysis duration: 71.3 +/- 28.9 mon ths; S-HD), except for the cases with diabetes mellitus, ischemic hear t disease, cardiac surgery or overt congestive heart failure. We selec ted 13 normotensive patients with normal kidney function as normal con trol group matched for sex and age (Control). Concerning with L-CAPD, S-CAPD, L-HD; and S-IID, these four groups were matched for age and or iginal diseases. We examined blood pressure (BP), cardiothoracic rate (CTR), anti-hypertensive (AHT) drugs and laboratory data. Wall thickne ss, left atrium, ventricular chamber size, ejection fraction (EF) and left ventricular mass (LV mass) [Devereux et al. 1986] were measured b y echocardiography. Peak early diastolic flow velocity (E), peak atria l filling velocity (A), A/E ratio and deceleration time of peak early diastolic flow velocity (DT) were calculated by analyzing transmitral flow, recorded by pulsed Doppler. BP control. CTR and EF were signific antly worse in L-CAPD than in other patient groups. A/E as one of para meters for cardiac diastolic function was significantly higher in L-CA PD than in HD patients. LVMI (LV mass index: LV mass/body surface area ) was significantly higher in L-CAPD than in other groups. LVMI in CAP D patients was shown to be significantly worse as time goes. Volume co ntrol by itself without AHT drugs could achieve good BP control in the long-term CAPD patients who were changed to maintenance hemodialysis because of peritoneal sclerosis. We concluded that LV hypertrophy and systolic dysfunction tend to progress in CAPD patients as time goes on . Also it is suggested that the cause of cardiac dysfunction in CAPD p atients was mainly based on poor BP control probably due to overhydrat ion, and chert fore, appropriate volume control in CAPD patients is es pecially important.