Nephrol Dial Transplant (2001) 16: 1459-1464
© 2001 European Renal Association-European Dialysis and Transplant Association
Long-term CAPD patients are volume expanded and display more severe left ventricular hypertrophy than haemodialysis patients
1 Centro di Fisiologia Clinica del CNR e Divisione di Nefrologia, Reggio Calabria, 2 Istituto di Medicina Interna ‘L. Condorelli’, Università di Catania, and 3 Servizio di Cardiologia Ospedale ‘E. Morelli’, Reggio Calabria, Italy
Background. Whether hypertension and left ventricular hypertrophy (LVH) are more prevalent in CAPD than in haemodialysis (HD) patients is still under discussion.
Methods. To examine this problem we compared a group of 51 CAPD patients, with a group of 201 HD patients. The evaluation included the measurement of atrial natriuretic peptide (atrial natriuretic factor (ANF)), taken as indicator of volume status, and echocardiographic measurements.
Results. CAPD patients were older, had been treated for a shorter time, and had lower serum albumin and phosphate than HD patients. Plasma ANF was higher (P<0.01) in CAPD (median 33.8 pmol/l (interquartile range 18.2–63.0)) than in HD patients (22.7 pmol/l (14.9–38.7)). Similarly, the left atrial volume was substantially higher (P<0.0001) in CAPD patients (49±22 ml) than in HD patients (37±17 ml), while the left ventricular end-diastolic diameter was similar in the two groups (CAPD 51±7 mm; HD 50±7 mm). Furthermore, left ventricular hypertrophy was more severe (P<0.0001) in CAPD (157±37 g/m2) than in HD patients (133±39 g/m2). The proportion of CAPD patients requiring antihypertensive drugs was markedly higher than that of HD patients (65 vs 38% P<0.001). Multivariate modelling showed that volume expansion and pressure load as well as serum albumin were independent predictors of left ventricular mass.
Conclusions. Left ventricular hypertrophy is more severe in long-term CAPD patients than in HD patients. This finding is associated with evidence of more pronounced volume expansion, hypertension, and hypoalbuminaemia. Volume and pressure load along with factors associated with hypoalbuminaemia may aggravate LVH in uraemic patients on CAPD.
Keywords: albumin; ANF; CAPD; haemodialysis; hypertension; left ventricular hypertrophy
Correspondence and offprint requests to: Giuseppe Enia and Carmine Zoccali, Centro di Fisiologia Clinica & Divisione di Nefrologia, Via Sbarre Inferiori 39, I-89131 Reggio Calabria, Italy.
* *Carmela Marino, Technician1, Rocco Tripepi, Technician1, Francesco Rapisarda MD5, Pasquale Fatuzzo MD4, Grazia Bonanno MD4, Giuseppe Seminara MD5, Benedetta Stancanelli MD5, Vincenzo Candela MD3, Carlo Labate MD3, O. Marzolla MD3, Filippo Tassone MD2.
1Centro di Fisiologia Clinica del CNR e Divisione di Nefrologia, Reggio Calabria; 2Servizio di Cardiologia Ospedale ‘E. Morelli’, Reggio Calabria; 3Servizio Dialisi Melito Porto Salvo, Reggio Calabria; 4Divisione Clinicizzata di Nefrologia Chirurgica, Università di Catania; 5Istituto di Medicina Interna e Geriatria, Università di Catania, Italy.
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