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. 2021 Mar;40(1):135-142.
doi: 10.23876/j.krcp.20.153. Epub 2021 Mar 23.

Changes in extracellular water and left ventricular mass in peritoneal dialysis patients

Theerasak Tangwonglert  1 , Andrew Davenport  2
Affiliations

Changes in extracellular water and left ventricular mass in peritoneal dialysis patients

Theerasak Tangwonglert et al. Kidney Res Clin Pract. 2021 Mar.

Abstract

Background: Increasing number of peritoneal dialysis (PD) patients are reported to have increased left ventricular hypertrophy (LVH), a major risk factor for cardiovascular mortality. We wished to determine which factors were most associated with changes in left ventricular mass index (LVMI).

Methods: We reviewed patient and treatment factors in prevalent PD patients with repeat echocardiograms 18 to 24 months apart, with corresponding bioimpedance measurements of extracellular water (ECW) and serum N-terminal pro-brain natriuretic peptide (NT-proBNP).

Results: We studied 60 patients (34 males, 35 with diabetes) who were treated with PD for a median of 14 months (2.5-26.3 months). All but one had LVH; on repeat echocardiography, there was no overall change in LVMI (106 [84-127] g/m2 vs. 108 [91-122] g/m2) despite a loss of residual renal function. Left ventricular mass increased in 34 (56.7%), and the percent change in LVMI was associated with percent change in NT-proBNP (r = 0.51, p = 0.017) and ECW/height (r = 0.32, p = 0.029), but not with ECW/total body water or changes in systolic or mean arterial pressure, urine output, 24-hour PD ultrafiltration, or net sodium balance. Only ECW/height remained independently associated with the percent change in LVMI in a multivariable model (odds ratio, 1.25; 95% confidence interval, 1.08-1.36; p = 0.007).

Conclusion: In this observational longitudinal report, a reduction in ECW/height was associated with regression of LVMI, whereas an increased ECW/height was associated with increased LVMI. As there was no corresponding association with systolic or mean arterial pressure, then volume expansion would appear to be a more significant factor in determining LVH than blood pressure.

Keywords: Hypertension; Hypertrophy; Peritoneal dialysis; Pro-brain natriuretic peptide (1-76); Water.

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Conflict of interest statement

Conflicts of interest

All authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.. Left ventricular mass index (LVMI) obtained by transthoracic two-dimensional echocardiography (Echo).
Medians, interquartile ranges, and 90% confidence intervals are indicated. **p < 0.01 and ***p < 0.001 vs. the group with increased LVMI.
See this image and copyright information in PMC

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