Association between bioimpedance analysis parameters and left ventricular hypertrophy in peritoneal dialysis patients

Abstract

Purpose: Chronic volume overload, hypertension and left ventricular hypertrophy are major risk factors contributing to the high mortality rate in peritoneal dialysis (PD) patients. In this study, we aimed to determine the impact of blood pressure measurements and volume status determined by bioelectrical impedance analysis (BIA) measurements over left ventricular hypertrophy (LVH) in PD patients.

Methods: Thirty-one prevalent PD patients were enrolled. Patients with a documented cardiovascular disease and uncontrolled hypertension were excluded. BIA and transthoracic echocardiography were performed in all patients All measurements were taken with the empty abdominal cavity. Routine laboratory parameters were also assessed in all patients. Extracellular water (ECW) in liters and ECW/total body water (TBW) ratio were used for determining volume status.

Results: Mean age of the patients was 43.9 ± 15.4 years, and mean PD duration was 39.5 ± 29.6 months. Mean ECW/TBW ratio was 44.3 %. Left ventricular mass index (LVMI) was 134.3 ± 34.9 g/m(2). Fifty-eight percent of patients had LVH. Mean LVMI was negatively correlated with daily urine volume (r -0.568, p 0.001) and weekly Kt/V (r -0.393, p 0.029); positively correlated with daily ultrafiltration (r +0.585, p 0.001) and office systolic (r +0.500, p 0.004) and diastolic (r +0.459, p 0.009) blood pressures. In linear regression analysis, daily urine volume (B -0.426, p 0.002) mean diastolic blood pressure (B 0.550, p <0.001), ECW/TBW ratio (B 0.313, p 0.02) and waist circumference (B 0.304, p 0.016) were independent risk factors for LVH.

Conclusions: We want to underline that, besides maintaining residual renal function, strict blood pressure control, particularly diastolic blood pressure, and avoiding hypervolemia and abdominal obesity should be main clinical goals in follow-up of PD patients in order to prevent LVH progression.