Bakkaloğlu S A, Ekim M, Koçak G, Atalay S, Tümer N
Department of Pediatric Nephrology, Ankara University Faculty of Medicine, Turkey.
Perit Dial Int. 2001 Jul-Aug;21(4):395-400.
Left ventricular hypertrophy is a major cause of morbidity and mortality among patients with chronic renal failure. Uremia-related risk factors play a fundamental role in its occurrence, thus better prognosis and prolonged survival can be attained by successful dialytic therapies.
To investigate whether dialysis adequacy has a beneficial effect on cardiac structure and function in children receiving continuous ambulatory peritoneal dialysis (CAPD).
Cross-sectional study in the Pediatric Peritoneal Dialysis Unit of a university hospital.
Eighteen children, aged 13.3 +/- 2.8 years, being treated with CAPD, and 20 healthy age- and sex-matched control subjects were enrolled in this study.
Echocardiographic evaluation was performed in all subjects. Dialysis adequacy indices [weekly urea (Kt/V) and creatinine clearance (TCCr)] were calculated in the dialysis group.
Interventricular septal thickness, left ventricular (LV) posterior wall thickness, LV mass index (LVMI), and LV end systolic and diastolic dimensions were all found to be significantly higher in the CAPD group compared to the control subjects (p < 0.01). Ejection fraction and fractional shortening of the LV were not significantly different between the two groups. Mean Kt/V was 2.02 +/- 0.71 and mean TCCr was 58 +/- 33 L/wk/1.73 m2. There were significant negative correlations between dialysis adequacy indices and LV end systolic and diastolic dimensions (p < 0.05 and p < 0.001). Ejection fraction and fractional shortening were positively correlated with Kt/V (p < 0.01). Systolic and diastolic blood pressures were positively correlated with LVMI (r= 0.501 and r = 0.523). Significant inverse correlations between mean arterial pressure and both Kt/V and TCCr (r = -0.555 and r = -0.520) were detected.
These data clearly document that cardiac structure and function are remarkably influenced by the uremic state and dialysis therapy in pediatric CAPD patients. The close relationships between echocardiographic findings and dialysis adequacy indices suggest that adequate dialysis has a beneficial effect on cardiac function via effective removal of toxic substances.
左心室肥厚是慢性肾衰竭患者发病和死亡的主要原因。与尿毒症相关的危险因素在其发生过程中起重要作用，因此通过成功的透析治疗可实现更好的预后和延长生存期。
探讨透析充分性对接受持续性非卧床腹膜透析（CAPD）的儿童心脏结构和功能是否有有益影响。
在一所大学医院的儿科腹膜透析单元进行的横断面研究。
本研究纳入了18名接受CAPD治疗的儿童，年龄为13.3±2.8岁，以及20名年龄和性别匹配的健康对照者。
对所有受试者进行超声心动图评估。在透析组中计算透析充分性指标[每周尿素清除率（Kt/V）和肌酐清除率（TCCr）]。
与对照组相比，CAPD组的室间隔厚度、左心室后壁厚度、左心室质量指数（LVMI）以及左心室收缩末期和舒张末期内径均显著更高（p<0.01）。两组之间左心室射血分数和缩短分数无显著差异。平均Kt/V为2.02±0.71，平均TCCr为58±33L/周/1.73m²。透析充分性指标与左心室收缩末期和舒张末期内径之间存在显著负相关（p<0.05和p<0.001）。射血分数和缩短分数与Kt/V呈正相关（p<0.01）。收缩压和舒张压与LVMI呈正相关（r=0.501和r=0.523）。检测到平均动脉压与Kt/V和TCCr均呈显著负相关（r=-0.555和r=-0.520）。
这些数据清楚地表明，尿毒症状态和透析治疗对儿科CAPD患者的心脏结构和功能有显著影响。超声心动图结果与透析充分性指标之间的密切关系表明，充分透析通过有效清除有毒物质对心脏功能有有益影响。
