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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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Kaplan–Meier curves for CV composite outcome (A), technique failure (B), and PD peritonitis (C). Patients with “faster” RRF decline rate (≤−1.60 mL/min/y/1.73 m2) showed significantly worse clinical outcomes compared with the “slower” RRF decline group. CV = cardiovascular, PD = peritoneal dialysis, RRF = residual renal function.
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Figure 2: Kaplan–Meier curves for CV composite outcome (A), technique failure (B), and PD peritonitis (C). Patients with “faster” RRF decline rate (≤−1.60 mL/min/y/1.73 m2) showed significantly worse clinical outcomes compared with the “slower” RRF decline group. CV = cardiovascular, PD = peritoneal dialysis, RRF = residual renal function.

Mentions: During a mean follow-up duration of 31.9 months, 4 (4.9%) patients died. The event rates for all-cause mortality, composite of death or hospitalization, infection composite, and new-onset CV disease were not different between the 2 groups. In contrast, compared with patients with “slower” RRF decline, the “faster” RRF decline group showed a significantly higher rate of technique failure (18.80 vs 4.19 events/100 patient-years [PY], P = 0.006). CV composite (20.29 vs 7.18 events/100 PY, P = 0.098) and PD peritonitis (15.73 vs 4.95 events/100 PY, P = 0.064) also developed more frequently in the “faster” RRF decline group, but the differences did not reach statistical significance (Table 7). However, Kaplan–Meier analysis revealed that CV composite, technical failure, and PD peritonitis event-free survivals were significantly higher in the “slower” RRF decline group compared with those in the “faster” RRF decline group (Figure 2).


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)

Kaplan–Meier curves for CV composite outcome (A), technique failure (B), and PD peritonitis (C). Patients with “faster” RRF decline rate (≤−1.60 mL/min/y/1.73 m2) showed significantly worse clinical outcomes compared with the “slower” RRF decline group. CV = cardiovascular, 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 2: Kaplan–Meier curves for CV composite outcome (A), technique failure (B), and PD peritonitis (C). Patients with “faster” RRF decline rate (≤−1.60 mL/min/y/1.73 m2) showed significantly worse clinical outcomes compared with the “slower” RRF decline group. CV = cardiovascular, PD = peritoneal dialysis, RRF = residual renal function.
Mentions: During a mean follow-up duration of 31.9 months, 4 (4.9%) patients died. The event rates for all-cause mortality, composite of death or hospitalization, infection composite, and new-onset CV disease were not different between the 2 groups. In contrast, compared with patients with “slower” RRF decline, the “faster” RRF decline group showed a significantly higher rate of technique failure (18.80 vs 4.19 events/100 patient-years [PY], P = 0.006). CV composite (20.29 vs 7.18 events/100 PY, P = 0.098) and PD peritonitis (15.73 vs 4.95 events/100 PY, P = 0.064) also developed more frequently in the “faster” RRF decline group, but the differences did not reach statistical significance (Table 7). However, Kaplan–Meier analysis revealed that CV composite, technical failure, and PD peritonitis event-free survivals were significantly higher in the “slower” RRF decline group compared with those in the “faster” RRF decline group (Figure 2).

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