Barman T K, Roy S, Hossain S M, Salahuddin A Z, Huq M O
Dr Tridip Kanti Barman, Assistant Professor, Department of Medicine, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
Mymensingh Med J. 2020 Oct;29(4):793-799.
Prevalence of heart failure (HF) among end stage renal disease (ESRD) patients is high and HF remains the main cardiovascular co-morbidity at dialysis initiation. There is paucity of data comparing change of NYHA class, improvement of ejection fraction (EF) and major cardiac events in ESRD patients with concomitant heart failure on haemodialysis to those on peritoneal dialysis. The objective of the study was to compare the cardiac outcome of continuous ambulatory peritoneal dialysis (CAPD) & hemodialysis (HD) in chronic kidney disease 5 (CKD5) patients with HF. This prospective observational study was carried out from March 2018 to February 2019 in seventy CKD 5 patients with HF who opted for CAPD or HD. Seven patients dropped out during the follow-up & sixty three patients (CAPD=31; HD=32) were followed up for symptomatic assessment of cardiac status in terms of NYHA class as well as echocardiography and serum haemoglobin at baseline and at 3rd & 6th month. Major cardiovascular events like non fatal MI, non fatal stroke & death duo to cardiovascular diseases and co-morbidities were recorded during the study period. Statistical analysis was done using SPSS 22.0. Mean age was 53.33±6.38 and 54.23±10.15 years & male to female ratio was 1.81:1 and 1.46:1 in CAPD and HD groups respectively. Both NYHA class & left ventricular ejection fraction (EF) were significantly increased after six months compared to baseline in each group and significantly more increased in the CAPD group than the HD group. Left ventricular internal diameter in diastole (LVIDd) was reduced significantly after six months compared to baseline in both groups and there was no significant difference in LVIDd reduction between the CAPD and HD groups. Major cardiovascular events were found to occur more frequently in the HD group. According to NYHA functional class, echocardiographic findings and major cardiovascular events during six months, improvement of cardiac function in CKD 5 patients with HF was better on CAPD in comparison to HD.
终末期肾病（ESRD）患者中心力衰竭（HF）的患病率很高，HF仍然是透析开始时主要的心血管合并症。关于血液透析与腹膜透析的ESRD合并心力衰竭患者，纽约心脏协会（NYHA）分级的变化、射血分数（EF）的改善以及主要心脏事件的对比数据很少。本研究的目的是比较持续性非卧床腹膜透析（CAPD）和血液透析（HD）在慢性肾脏病5期（CKD5）合并HF患者中的心脏结局。这项前瞻性观察性研究于2018年3月至2019年2月对70例选择CAPD或HD的CKD5合并HF患者进行。7例患者在随访期间退出，63例患者（CAPD组=31例；HD组=32例）接受了随访，以根据NYHA分级以及基线、第3个月和第6个月时的超声心动图和血清血红蛋白对心脏状况进行症状评估。在研究期间记录了重大心血管事件，如非致命性心肌梗死、非致命性中风以及因心血管疾病和合并症导致的死亡。使用SPSS 22.0进行统计分析。CAPD组和HD组的平均年龄分别为53.33±6.38岁和54.23±10.15岁，男女比例分别为1.81:1和1.46:1。与基线相比，每组在6个月后NYHA分级和左心室射血分数（EF）均显著增加，且CAPD组的增加幅度显著大于HD组。与基线相比，两组在6个月后舒张期左心室内径（LVIDd）均显著减小，且CAPD组和HD组在LVIDd减小方面无显著差异。发现重大心血管事件在HD组中更频繁发生。根据NYHA功能分级、超声心动图结果以及6个月内的重大心血管事件，CKD5合并HF患者的心脏功能在CAPD治疗时比HD治疗时改善得更好。
