Dynamic cardiac dyssynchrony is strongly associated with 2-year dialysis adequacy in continuous ambulatory peritoneal dialysis patients

BMC Nephrology

Yu-Jun Chang³  Tzu-Lan Chang¹  Chia-Chu Chang²  Ching-Hui Huang¹ 

[1] Vascular and Genomic Research Center, Changhua Christian Hospital, Changhua, Taiwan;School of Medicine, Chung Shan Medical University, Taichung, Taiwan;Epidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan

关键词: Left ventricular dyssynchrony;    Continuous ambulatory peritoneal dialysis;    3D dobutamine echocardiography;   

Others  :  1082971
DOI  :  10.1186/1471-2369-14-68

 received in 2012-07-01, accepted in 2013-03-20,  发布年份 2013

【 摘 要 】

Background

Left ventricular (LV) dyssynchrony is associated with increased risk of all-cause mortality in patients with end-stage renal disease. Our aim was to determine the associations of LV dynamic dyssynchrony with peritoneal solute clearance in continuous ambulatory peritoneal dialysis (CAPD) patients. Our primary objective was to determine the association between dynamic LV dyssynchrony and CAPD clearance at 2 years. Secondary objectives were to identify the factors influencing dynamic dyssynchrony, and to examine the association between dialysis adequacy and echocardiography-assessed LV outcomes.

Methods

Fifty CAPD patients and 13 healthy volunteers underwent three-dimensional (3D) dobutamine stress echocardiography (DSE). The main endpoint was systolic dyssynchrony index (SDI). Secondary endpoints, including NT-proBNP, troponin I, Kt/V, and biochemical parameters, were measured before stress echocardiography, and Kt/V was measured again 2 years later. All values are expressed as medians and interquartile ranges (IQR).

Results

NT-proBNP (3872 [808–11779] vs. 4.99 [4.99–36.83] pg/mL, P < 0.001), and log NT-proBNP (3.587 [2.896–4.071] vs. 0.698 [0.698–1.540], P < 0.001) levels were significantly higher in the CAPD group than in the control group. Real-time 3D DSE showed that the systolic dyssynchrony index was significantly different between the two groups at the peak dobutamine stage (1.11% [0.76–1.64%] vs. 0.66% [0.50–1.02%], P = 0.004), but not at resting (1.30% [0.89–1.74%] vs. 1.22 % [0.72–1.68%], P = 0.358).The subgroup of patients in the CAPD group with greater improvements in dialysis adequacy had lower baseline dynamic SDI and more favorable echocardiographic findings at 2 years. Dialysis adequacy decreased significantly at 2 year in patients with higher, but not in those with lower dynamic SDI at baseline. In multivariate linear regression analysis, log NT-proBNP and SDI at the peak dobutamine dose were significantly associated with Kt/V and weekly creatinine clearance at 2 years, while log NT-proBNP was significant associated with SDI at the peak dobutamine stage. Female CAPD patients group had more pronounced dynamic LV dyssynchrony compared with male patients.

Conclusions

Dynamic systolic dyssynchrony was strongly associated with future dialysis adequacy in CAPD patients. Log NT-proBNP was the important predictor of dynamic dyssynchrony. Our study confirmed the concept that cardiac dysfunction has an impact on dialysis adequacy.

【 授权许可】

   
2013 Huang et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Krediet RT, Lindholm B, Rippe B: Pathophysiology of peritoneal membrane failure. Perit Dial Int 2000, 20:22-42.
• [2]Rosengren BI, Rippe B: Blood flow limitation in vivo of small solute transfer during peritoneal dialysis in rats. J Am Soc Nephrol 2003, 14:1599-604.
• [3]Sawada T, Ishii Y, Tojimbara T, Nakajima I, Fuchinoue S, Teraoka S: The ACE inhibitor, quinapril, ameliorates peritoneal fibrosis in an encapsulating peritoneal sclerosis model in mice. Pharmacol Res 2002, 46:505-510.
• [4]Gayat E, Mor-Avi V, Weinert L, Shah SJ, Yodwut C, Lang RM: Noninvasive Estimation of Left Ventricular Compliance Using Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2012, 25:661-666.
• [5]Unzek S, Popovic ZB, Marwick TH: Effect of recommendations on interobserver consistency of diastolic function evaluation. JACC Cardiovasc Imaging 2011, 4:460-467.
• [6]Paniagua R, Ventura MD, Avila-Díaz M, Hinojosa-Heredia H, Méndez-Durán A, Cueto-Manzano A, Cisneros A, Ramos A, Madonia-Juseino C, Belio-Caro F, García-Contreras F, Trinidad-Ramos P, Vázquez R, Ilabaca B, Alcántara G, Amato D: NT-proBNP, fluid volume overload and dialysis modality is independent predictors of mortality in ESRD patients. Nephrol Dial Transplant 2010, 25:551-557.
• [7]Krittayaphong R, Boonyasirinant T, Saiviroonporn P, Thanapiboonpol P, Nakyen S, Udompunturak S: Correlation between NT-pro BNP levels and left ventricular wall stress, SIand extent of myocardial damage: a magnetic resonance imaging study. J Card Fail 2008, 14:687-694.
• [8]Gangji AS, Helal BA, Churchill DN, Brimble KS, Margetts PJ: Association between N-terminal propeptide B-type natriuretic peptide and markers of hypervolemia. Perit Dial Int 2008, 28:308-311.
• [9]Badano LP, Boccalini F, Muraru D, Bianco LD, Peluso D, Bellu R, Zoppellaro G, Iliceto S: Current clinical applications of transthoracic three-dimensional echocardiography. J Cardiovasc Ultrasound 2012, 20:1-22.
• [10]Kapetanakis S, Kearney MT, Siva A, Gall N, Cooklin M, Monaghan MJ: Real-time three-dimensional echocardiography: a novel technique to quantify global left ventricular mechanical dyssynchrony. Circulation 2005, 112:992-1000.
• [11]Messika-Zeitoun D, Bellamy M, Avierinos JF, Breen J, Eusemann C, Rossi A, Behrenbeck T, Scott C, Tajik JA, Enriquez-Sarano M: Left atrial remodeling in mitral regurgitation–methodologic approach, physiological determinants, and outcome implications: a prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study. Eur Heart J 2007, 28:1773-1781.
• [12]Lentine KL, Hurst FP, Jindal RM, Villines TC, Kunz JS, Yuan CM, Hauptman PJ, Abbott KC: Cardiovascular Risk Assessment Among Potential Kidney Transplant Candidates: Approaches and Controversies. Am J Kidney Dis 2010, 5:152-167.
• [13]Lancellotti P, Moonen M: Left ventricular dyssynchrony: a dynamic condition. Heart Fail Rev 2012, 17:747-753.
• [14]Matsumura Y, Hozumi T, Arai K, Sugioka K, Ujino K, Takemoto Y, Yamagishi H, Yoshiyama M, Yoshikawa J: Non-invasive assessment of myocardial ischaemia using new real-time three-dimensional dobutamine stress echocardiography: comparison with conventional two-dimensional methods. Eur Heart J 2005, 26:1625-1632.
• [15]London GM, Guerin AP, Pannier B, Marchais SJ, Safar ME: Large artery structure and function in hypertension and end-stage renal disease. J Hypertens 1998, 16:1931-1938.
• [16]Wieskotten S, Heinke S, Wabel P, Moissl U, Becker J, Pirlich M, Keymling M, Isermann R: Bioimpedance-based identification of malnutrition using fuzzy logic. Physiol Meas 2008, 29:639-654.
• [17]Kobayashi D, Patel SR, Mattoo TK, Valentini RP, Aggarwal S: The impact of change in volume and left-ventricular hypertrophy on left-ventricular mechanical dyssynchrony in children with end-stage renal disease. Pediatr Cardiol 2012, 33:1124-1130.
• [18]Hayashi SY, Seeberger A, Lind B, Nowak J, Do Nascimento MM, Lindholm B, Brodin LA: A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease: a pilot tissue synchronization imaging study. Nephrol Dial Transplant 2008, 23:3622-3628.
• [19]Aljaroudi W, Aggarwal H, Venkataraman R, Heo J, Iskandrian AE, Hage FG: Impact of left ventricular dyssynchrony by phase analysis on cardiovascular outcomes in patients with end-stage renal disease. J Nucl Cardiol 2010, 17:1058-1064.
• [20]Bakkaloğlu SA, Ekim M, Koçak G, Atalay S, Tümer N: Impact of dialysis adequacy on cardiac function in pediatric CAPD patients. Perit Dial Int 2001, 21:395-400.
• [21]Wang J, Kurrelmeyer KM, Torre-Amione G, Nagueh SF: Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy. J Am Coll Cardiol 2007, 49:88-96.
• [22]Ateş K, Nergizoğlu G, Keven K, Sen A, Kutlay S, Ertürk S, Duman N, Karatan O, Ertuğ AE: Effect of fluid and sodium removal on mortality in peri¬toneal dialysis patients. Kidney Int 2001, 60:767-776.
• [23]Chen W, Guo LJ, Wang T: Extracellular water/intracellular water is a strong predictor of patient survival in incident peritoneal dialysis patients. Blood Purif 2007, 25:260-266.
• [24]Van Biesen W, Williams JD, Covic AC, Fan S, Claes K, Lichodziejewska-Niemierko M, Verger C, Steiger J, Schoder V, Wabel P, Gauly A, Himmele R, EuroBCM Study Group: Fluid status in peritoneal dialysis patients: the European Body Composition Monitoring (EuroBCM) study cohort. PLoS One 2011, 6:e17148.
• [25]Kang PM, Izumo S: Apoptosis and heart failure: A critical review of the literature. Circ Res 2000, 86:1107-1113.
• [26]Wilson EM, Moainie SL, Baskin JM, Lowry AS, Deschamps AM, Mukherjee R, Guy TS, St John-Sutton MG, Gorman JH 3rd, Edmunds LH Jr, Gorman RC, Spinale FG: Region- and type-specific induction of matrix metalloproteinases in post-myocardial infarction remodeling. Circulation 2003, 107:285-2863.
• [27]Ratcliffe MB: Non-ischemic infarct extension: A new type of infarct enlargement and a potential therapeutic target. J Am Coll Cardiol 2002, 40:1168-1171.
• [28]Sadoshima J, Jahn L, Takahashi T, Kulik TJ, Izumo S: Molecular characterization of the stretch-induced adaptation of cultured cardiac-cells -an in vitro model of load-induced cardiac-hypertrophy. J Biol Chem 1992, 267:10551-10560.
• [29]Kuznetsova T, Bogaert P, Kloch-Badelek M, Thijs D, Thijs L, Staessen JA: Association of left ventricular diastolic function with systolic dyssynchrony: a population study. Eur Heart J Cardiovasc Imaging 2012. Sep 21. [Epub ahead of print]
• [30]Cavasin MA, Sankey SS, Yu AL, Menon S, Yang XP: Estrogen and testosterone have opposing effects on chronic cardiac remodeling and function in mice with myocardial infarction. AJP-Heart Circ Physiol 2003, 284:1560-1569.