Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
Urology, Yaizu City Hospital, Shizuoka, Japan.
BMC Nephrol. 2021 Apr 16;22(1):135. doi: 10.1186/s12882-021-02321-1.
Concentric left ventricular hypertrophy (cLVH) is a common left ventricular geometric pattern in patients undergoing maintenance dialysis, including peritoneal dialysis (PD). The relationship between cLVH at PD initiation and the prognosis of patients remains unclear, however. This study aimed to investigate the impact of cLVH at PD initiation on patient survival and major adverse cardiovascular events (MACE).
The retrospective cohort study included 131 patients who underwent echocardiography during the PD initiation period. Based on echocardiographic measurements, cLVH was defined as a condition with increased LV mass index and increased relative wall thickness. The relationship between cLVH and the prognosis was assessed.
Concentric LVH was identified in 29 patients (22%) at PD initiation, and patient survival, MACE-free survival and PD continuation were significantly reduced in the cLVH group compared with the non-cLVH group. In the Cox regression analysis, cLVH was demonstrated as an independent risk factor of mortality (HR [95%CI]: 3.32 [1.13-9.70]) for all patients. For patients over 65 years old, cLVH was significantly associated with mortality and MACE (HR [95%CI]: 3.51 [1.06-11.58] and 2.97 [1.26-7.01], respectively). Serum albumin at PD initiation was independently correlated with cLVH.
In our study, cLVH at PD initiation was independently associated with survival in all patients and with both survival and MACE in elderly patients. Evaluation of LV geometry at PD initiation might therefore help identify high-risk patients. Further studies involving larger numbers of patients are needed to confirm the findings from this study and clarify whether treatment interventions for factors such as nutrition status could ameliorate cLVH and improve patient outcomes.
同心性左心室肥厚（cLVH）是接受维持性透析治疗患者的一种常见左心室几何构型，包括腹膜透析（PD）患者。然而，PD 起始时 cLVH 与患者预后之间的关系尚不清楚。本研究旨在探讨 PD 起始时 cLVH 对患者生存和主要不良心血管事件（MACE）的影响。
这项回顾性队列研究纳入了 131 名在 PD 起始期间接受超声心动图检查的患者。根据超声心动图测量结果，将 cLVH 定义为左心室质量指数增加和相对室壁厚度增加的情况。评估 cLVH 与预后之间的关系。
在 PD 起始时，29 名（22%）患者存在 cLVH，与非 cLVH 组相比，cLVH 组患者的生存、无 MACE 生存和 PD 继续率显著降低。在 Cox 回归分析中，cLVH 被证明是所有患者死亡的独立危险因素（HR [95%CI]：3.32 [1.13-9.70]）。对于 65 岁以上的患者，cLVH 与死亡率和 MACE 显著相关（HR [95%CI]：3.51 [1.06-11.58] 和 2.97 [1.26-7.01]）。PD 起始时的血清白蛋白与 cLVH 独立相关。
在我们的研究中，PD 起始时的 cLVH 与所有患者的生存以及老年患者的生存和 MACE 独立相关。因此，评估 PD 起始时的 LV 几何结构可能有助于识别高危患者。需要进一步开展纳入更多患者的研究来证实本研究的结果，并阐明是否可以通过营养状况等因素的治疗干预来改善 cLVH 并改善患者预后。
