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Changes in echocardiographic parameters according to the rate of residual renal function decline in incident peritoneal dialysis patients.

Koo HM, Doh FM, Kim CH, Lee MJ, Kim EJ, Han JH, Han JS, Ryu DR, Oh HJ, Park JT, Han SH, Yoo TH, Kang SW - Medicine (Baltimore) (2015)

Bottom Line: During a mean follow-up duration of 31.9 months, 4 (4.9%) patients died.On multivariate Cox regression analysis, patients with "faster" RRF decline rate showed 4.82-, 4.44-, and 7.37-fold higher risks, respectively, for each clinical outcome.Preservation of RRF is important for conserving cardiac performance, resulting in an improvement in clinical outcomes of incident PD patients.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Internal Medicine (HMK, FMD, CHK, MJL, EJK, JHH, JSH, HJO, JTP, SHH, T-HY, S-WK), College of Medicine, Yonsei University; Department of Internal Medicine (D-RR), School of Medicine, Ewha Womans University; and Severance Biomedical Science Institute (S-WK), Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, South Korea.

ABSTRACT
Residual renal function (RRF) is associated with left ventricular (LV) hypertrophy as well as all-cause and cardiovascular (CV) mortality in patients with end-stage renal disease. However, no studies have yet examined the serial changes in echocardiographic findings according to the rate of RRF decline in incident dialysis patients. A total of 81 patients who started peritoneal dialysis (PD) between 2005 and 2012 at Yonsei University Health System, Seoul, South Korea, and who underwent baseline and follow-up echocardiography within the first year of PD were recruited. Patients were dichotomized into "faster" and "slower" RRF decline groups according to the median values of RRF decline slope (-1.60 mL/min/y/1.73 m(2)). Baseline RRF and echocardiographic parameters were comparable between the 2 groups. During the first year of PD, there were no significant changes in LV end-diastolic volume index (LVEDVI), left atrial volume index (LAVI), or LV mass index (LVMI) in the "faster" RRT decline group, while these indices decreased in the "slower" RRT decline group. The rate of RRF decline was a significant determinant of 1-year changes in LVEDVI, LAVI, and LVMI. The linear mixed model further confirmed that there were significant differences in the changes in LVEDVI, LAVI, and LVMI between the 2 groups (P = 0.047, 0.048, and 0.001, respectively). During a mean follow-up duration of 31.9 months, 4 (4.9%) patients died. Compared with the "slower" RRF decline group, CV composite (20.29/100 vs 7.18/100 patient-years [PY], P = 0.098), technique failure (18.80/100 vs 4.19/100 PY, P = 0.006), and PD peritonitis (15.73/100 vs 4.95/100 PY, P = 0.064) developed more frequently in patients with "faster" RRF decline rate. On multivariate Cox regression analysis, patients with "faster" RRF decline rate showed 4.82-, 4.44-, and 7.37-fold higher risks, respectively, for each clinical outcome. Preservation of RRF is important for conserving cardiac performance, resulting in an improvement in clinical outcomes of incident PD patients.

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Time-dependent serial changes in echocardiographic parameters according to the rate of RRF decline. During the first year of PD, LVEDVI (A), LAVI (B), and LVMI (C) decreased continuously in patients with “slower” RRF decline, while no improvement or a slightly deteriorating pattern was observed in the “faster” RRF decline group. LAVI = left atrial volume index, LVEDVI = left ventricular end-diastolic volume index, LVMI = left ventricular mass index, PD = peritoneal dialysis, RRF = residual renal function.
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Figure 1: Time-dependent serial changes in echocardiographic parameters according to the rate of RRF decline. During the first year of PD, LVEDVI (A), LAVI (B), and LVMI (C) decreased continuously in patients with “slower” RRF decline, while no improvement or a slightly deteriorating pattern was observed in the “faster” RRF decline group. LAVI = left atrial volume index, LVEDVI = left ventricular end-diastolic volume index, LVMI = left ventricular mass index, PD = peritoneal dialysis, RRF = residual renal function.

Mentions: On a simple comparison using Student t test, there were significant decreases in LVEDVI, LV end-systolic volume index (LVESVI), LAVI, and LVMI during the first year of PD in patients with “slower” RRF decline compared with those in the “faster” RRF decline group (Table 3). In addition, the rate of RRF decline was a significant independent factor associated with changes in LVEDVI, LAVI, and LVMI on multivariate linear regression analysis (Table 4). Next, we compared the time-dependent 1-year serial changes in echocardiographic parameters between the “faster” and “slower” RRF decline groups (Table 5; Figure 1; Supplementary Figure 1, http://links.lww.com/MD/A167). LVEDVI and LVMI values were comparable between the 2 groups at baseline and decreased similarly until 6 months. After 6 months, however, patients with “slower” RRF decline showed a continuous regression pattern, while these values stopped decreasing in the “faster” RRF decline group, resulting in significant differences between the 2 groups at 12 months (P = 0.045 and 0.003, respectively). LMM further confirmed that the overall reduction rates of LVEDVI and LVMI were significantly greater in patients with “slower” RRF decline compared with those in the “faster” RRF decline group, even after adjusting for confounding factors (P = 0.047 and 0.001, respectively). LAVI also decreased gradually in the “slower” RRF decline group, while it was slightly increased at 6 and 12 months in the “faster” RRF decline group, resulting in a significant difference in LMM (P = 0.048).


Changes in echocardiographic parameters according to the rate of residual renal function decline in incident peritoneal dialysis patients.

Koo HM, Doh FM, Kim CH, Lee MJ, Kim EJ, Han JH, Han JS, Ryu DR, Oh HJ, Park JT, Han SH, Yoo TH, Kang SW - Medicine (Baltimore) (2015)

Time-dependent serial changes in echocardiographic parameters according to the rate of RRF decline. During the first year of PD, LVEDVI (A), LAVI (B), and LVMI (C) decreased continuously in patients with “slower” RRF decline, while no improvement or a slightly deteriorating pattern was observed in the “faster” RRF decline group. LAVI = left atrial volume index, LVEDVI = left ventricular end-diastolic volume index, LVMI = left ventricular mass index, PD = peritoneal dialysis, RRF = residual renal function.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554171&req=5

Figure 1: Time-dependent serial changes in echocardiographic parameters according to the rate of RRF decline. During the first year of PD, LVEDVI (A), LAVI (B), and LVMI (C) decreased continuously in patients with “slower” RRF decline, while no improvement or a slightly deteriorating pattern was observed in the “faster” RRF decline group. LAVI = left atrial volume index, LVEDVI = left ventricular end-diastolic volume index, LVMI = left ventricular mass index, PD = peritoneal dialysis, RRF = residual renal function.
Mentions: On a simple comparison using Student t test, there were significant decreases in LVEDVI, LV end-systolic volume index (LVESVI), LAVI, and LVMI during the first year of PD in patients with “slower” RRF decline compared with those in the “faster” RRF decline group (Table 3). In addition, the rate of RRF decline was a significant independent factor associated with changes in LVEDVI, LAVI, and LVMI on multivariate linear regression analysis (Table 4). Next, we compared the time-dependent 1-year serial changes in echocardiographic parameters between the “faster” and “slower” RRF decline groups (Table 5; Figure 1; Supplementary Figure 1, http://links.lww.com/MD/A167). LVEDVI and LVMI values were comparable between the 2 groups at baseline and decreased similarly until 6 months. After 6 months, however, patients with “slower” RRF decline showed a continuous regression pattern, while these values stopped decreasing in the “faster” RRF decline group, resulting in significant differences between the 2 groups at 12 months (P = 0.045 and 0.003, respectively). LMM further confirmed that the overall reduction rates of LVEDVI and LVMI were significantly greater in patients with “slower” RRF decline compared with those in the “faster” RRF decline group, even after adjusting for confounding factors (P = 0.047 and 0.001, respectively). LAVI also decreased gradually in the “slower” RRF decline group, while it was slightly increased at 6 and 12 months in the “faster” RRF decline group, resulting in a significant difference in LMM (P = 0.048).

Bottom Line: During a mean follow-up duration of 31.9 months, 4 (4.9%) patients died.On multivariate Cox regression analysis, patients with "faster" RRF decline rate showed 4.82-, 4.44-, and 7.37-fold higher risks, respectively, for each clinical outcome.Preservation of RRF is important for conserving cardiac performance, resulting in an improvement in clinical outcomes of incident PD patients.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Internal Medicine (HMK, FMD, CHK, MJL, EJK, JHH, JSH, HJO, JTP, SHH, T-HY, S-WK), College of Medicine, Yonsei University; Department of Internal Medicine (D-RR), School of Medicine, Ewha Womans University; and Severance Biomedical Science Institute (S-WK), Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, South Korea.

ABSTRACT
Residual renal function (RRF) is associated with left ventricular (LV) hypertrophy as well as all-cause and cardiovascular (CV) mortality in patients with end-stage renal disease. However, no studies have yet examined the serial changes in echocardiographic findings according to the rate of RRF decline in incident dialysis patients. A total of 81 patients who started peritoneal dialysis (PD) between 2005 and 2012 at Yonsei University Health System, Seoul, South Korea, and who underwent baseline and follow-up echocardiography within the first year of PD were recruited. Patients were dichotomized into "faster" and "slower" RRF decline groups according to the median values of RRF decline slope (-1.60 mL/min/y/1.73 m(2)). Baseline RRF and echocardiographic parameters were comparable between the 2 groups. During the first year of PD, there were no significant changes in LV end-diastolic volume index (LVEDVI), left atrial volume index (LAVI), or LV mass index (LVMI) in the "faster" RRT decline group, while these indices decreased in the "slower" RRT decline group. The rate of RRF decline was a significant determinant of 1-year changes in LVEDVI, LAVI, and LVMI. The linear mixed model further confirmed that there were significant differences in the changes in LVEDVI, LAVI, and LVMI between the 2 groups (P = 0.047, 0.048, and 0.001, respectively). During a mean follow-up duration of 31.9 months, 4 (4.9%) patients died. Compared with the "slower" RRF decline group, CV composite (20.29/100 vs 7.18/100 patient-years [PY], P = 0.098), technique failure (18.80/100 vs 4.19/100 PY, P = 0.006), and PD peritonitis (15.73/100 vs 4.95/100 PY, P = 0.064) developed more frequently in patients with "faster" RRF decline rate. On multivariate Cox regression analysis, patients with "faster" RRF decline rate showed 4.82-, 4.44-, and 7.37-fold higher risks, respectively, for each clinical outcome. Preservation of RRF is important for conserving cardiac performance, resulting in an improvement in clinical outcomes of incident PD patients.

Show MeSH
Related in: MedlinePlus