Takeda K, Nakamoto M, Hirakata H, Baba M, Kubo M, Fujishima M
Kidney Center, Division of Internal Medicine, Saiseikai Yahata Hospital, Fukuoka, Japan.
Am J Kidney Dis. 1998 Sep;32(3):482-7. doi: 10.1053/ajkd.1998.v32.pm9740166.
The indices of cardiac performances were compared between 31 continuous ambulatory peritoneal dialysis (CAPD) and 20 long-term hemodialysis (HD) patients. They were subdivided into three groups according to dialysis duration: L-CAPD (n = 16, mean age and CAPD duration were, respectively, 53 +/- 8 [SD] years and 77 +/- 13 months); S-CAPD (n = 15; 52 +/- 12 years, 28 +/- 12 months); HD (n = 20; 51 +/- 10 years, 162 +/- 52 months). The diabetic HD patients (DM-HD; n = 13; 60 +/- 13 years of age, 22 +/- 11 months) were chosen separately. Thirteen normotensive subjects with normal kidney function (mean age, 57 +/- 9 years) were selected as an age-matched control group. There were no significant differences between groups in age, gender, incidence of original kidney disease, or serum biochemical data. The blood pressure and the cardiothoracic ratio in L-CAPD were highest among groups. The indices of left ventricular (LV) hypertrophy as well as LV performance by means of echocardiography or pulsed Doppler were compared. Among nondiabetic dialysis patients, the calculated LV mass index (LVMI) of 166.4 +/- 84.3 g/m2 and the ratio of the peak atrial filling velocity to the peak diastolic flow velocity of 1.25 +/- 0.4 in L-CAPD were greatest, and the left ventricular fractional shortening (%FS) of 34.2 +/- 10.8% in L-CAPD was smallest. LVMI or %FS of L-CAPD was the same as DM-HD of 161.0 +/- 40.7 g/m2 or 31.6 +/- 8.2%. Possibly, poor control of hypervolemia, which is caused by peritoneal problems induced by either peritonitis or chronic exposure to high-glucose dialysate, causes a substantial cardiac preload leading to incipient cardiac failure in L-CAPD. According to the similar results of L-CAPD and DM-HD, it may be that hypertension, hyperlipidemia, or long-term constant glucose loading of CAPD fluids in addition to impaired glucose tolerance by chronic renal failure is more or less related to the progression of LV hypertrophy and latent cardiac dysfunction in long-term CAPD patients. In this context, CAPD of more than 5 years' duration is disadvantageous for preserving cardiac function as compared with HD.
比较了31例持续性非卧床腹膜透析（CAPD）患者和20例长期血液透析（HD）患者的心脏功能指标。根据透析时间将他们分为三组：长期CAPD组（L-CAPD，n = 16，平均年龄和CAPD时间分别为53±8[标准差]岁和77±13个月）；短期CAPD组（S-CAPD，n = 15；52±12岁，28±12个月）；HD组（n = 20；51±10岁，162±52个月）。另外选取了13例糖尿病HD患者（DM-HD；n = 13；年龄60±13岁，透析时间22±11个月）。选择13例肾功能正常的血压正常受试者（平均年龄57±9岁）作为年龄匹配的对照组。各组在年龄、性别、原发性肾病发生率或血清生化数据方面无显著差异。L-CAPD组的血压和心胸比在各组中最高。通过超声心动图或脉冲多普勒比较左心室（LV）肥厚指标以及LV功能。在非糖尿病透析患者中，L-CAPD组计算得出的左心室质量指数（LVMI）为166.4±84.3 g/m²，心房充盈峰值速度与舒张期峰值流速之比为1.25±0.4，是最大的，而L-CAPD组的左心室短轴缩短率（%FS）为34.2±10.8%，是最小的。L-CAPD组的LVMI或%FS与DM-HD组的161.0±40.7 g/m²或31.6±8.2%相同。可能是由于腹膜炎或长期接触高糖透析液引起的腹膜问题导致的高血容量控制不佳，在L-CAPD中导致大量心脏前负荷，从而引发早期心力衰竭。根据L-CAPD和DM-HD的相似结果，除了慢性肾衰竭导致的糖耐量受损外，高血压、高脂血症或CAPD液的长期持续葡萄糖负荷可能或多或少与长期CAPD患者的LV肥厚进展和潜在心脏功能障碍有关。在这种情况下，与HD相比，透析时间超过5年的CAPD对心脏功能的保护是不利的。
