| Objective. To make clear whether the degree of the left heart chambers enlargement and the left ventricular hypertrophy in long-term continuous ambulatory peritoneal dialysis(CAPD) is different from that in haemodialysis(HD) patients after water and salt intake restriction, we compared the volume load and echocardiographic parameters between them. Furthermore, we investigated whether the volume overload and blood pressure could lead to left heart chambers enlargement and left ventricular hypertrophy. To decrease the left heart chambers enlargement and the left ventricular hypertrophy in CAPD patients, medical personnel should pay more attention to water and salt intake restriction.Methods. To examine this problem we selected 20 patients with CAPD and 30 patients with HD from 32 CAPD and 67 HD patients who had received dialysis in our hospital from Jan, 2006 to May, 2007. All these patients had been on dialysis and had restricted water and salt intake for more than six months without peritonitis during the last 2 months. Excluded from the study were those patients with heart failure and severe valvular heart disease. Clinical characteristics of the CAPD or HD patients who had not been selected were similar to the study group with respect to age, sex, duration of CAPD or HD treatment and aetiology of renal disease. Intravascular volume status was determined using the ratio(VCD) of inferior vena cava diameter(IVCD) with an empty abdomen to body surface area(BSA). Each patient underwent an echocardiographic measurements with following parameters: left atrial diameter(LAD), left ventricularend-diastolic diameter(LVDd), left ventricular posterior wall thickness(LVPWT), interventricular septal thickness(LVST)and ejection fraction (EF). Left ventricular mass index(LVMI)was calculated according to Devereu and Reicheck formula: LVMI = left ventricular mass(LVM)/body surface area ( BSA ) , LVM= 1.04* [ ( LVST+ LVPWT+ LVDd ) 3- LVDd3]-13.6,BSA=[0.006*body height(cm)+0.0128*body weight(kg)]. Left atrial enlargement was defined as LAD﹥38mm and left ventricular enlargement was defined as LVDd: male﹥55mm, female﹥50mm. Left ventricular hypertrophy was defined as LVMI﹥134g/m2 in males and 110g/m2 in females. Whole blood chemistry including hemoglobin, serum albumin, calcium and phosphate were analyzed by laboratory procedures. Blood pressure(BP) was performed several times and mean systolic pressure was calculated. All calculations were done by SPSS 11.5. Data were expressed as mean±SD and comparisons between groups were made by t-test, Mann-Whitney or Chi-square test. To determine whether the left heart chambers enlargement and the left ventricular hypertrophy were related to age, blood pressure, volume load, hemoglobin, serum albumin, serum calcium and phosphate, we used the correlative analysis. A P value less than 0.05 was considered significant.Results. CAPD patients had lower serum albumin(P﹤0.001) and had higher proportion of diabetes(P﹤0.05) than HD patients. There were not differences in age, dialysis duration, sex, hemoglobin, serum calcium and phosphate and the proportion of EPO application between the two groups(P﹥0.05).The systolic pressure was similar in the two groups(P﹥0.05). The proportion of CAPD patients requiring antihypertensive drugs was markedly lower than that of HD patients( 38 vs 66.7%,P﹤0.05 ).The VCD was lower( P﹤0.01) in CAPD( 8.28±1.62 mm/m2 ) than that in HD patients(10.39±2.31 mm/m2). The difference of VCD between the two groups denoted that CAPD patients had lower volume load than HD patients. The LAD was lower(P﹤0.01)in CAPD patients (33.73±7.69mm) than in HD patients (39.54±6.78mm) and the LVDd was lower(P﹤0.05)in CAPD patients (46.59±9.16mm) than in HD patients (52.29±5.76mm). The proportion of the left atrial enlargement was 25% in CAPD patients and53% in HD patients and the proportion of the left ventricular enlargement was 10% in CAPD patients and 43% in HD patients. The percentage of the left heart chambers enlargement of the two groups had statistic difference(P﹤0.05). The LVPWT(CAPD 11.57±1.16mm,HD10.92±1.76mm), the LVST( CAPD11.7±1.23mm,HD11.45±1.66mm ) and the LVMI (CAPD139.22±54.15mm, HD 153.41±41.39mm)were similar(P﹥0.05) in the two groups. The proportion of the left ventricular hypertrophy was 65% in CAPD patients and 70% in HD patients. The percentage of the left ventricular hypertrophy of the two groups had not statistic difference(P﹥0.05).The correlative analysis found that the left heart chambers and the left ventricular hypertrophy had little correlation to age , dialysis duration, hemoglobin, serum albumin, diabetes, serum calcium and phosphate, but had obvious positive correlation to VCD(LAD :r=0.537,P﹤0.001;LVDd:r=0.605,P﹤0.001;LVMI: r=0.652,P﹤0.001)and systolic pressur(eLAD :r=0.467,P﹤0.001;LVDd:r=0.614,P﹤0.001;LVMI: r=0.822,P﹤0.001). Conclusions.The volume load(VCD) of CAPD patients, the proportion of CAPD patients requiring antihypertensive drugs and the degree of the left heart chambers enlargement were markedly lower than that of HD patients after water and salt restriction, which indicated that water and salt intake restriction may prevent the left heart chambers enlargement by reducing volume overload and controlling hypertension in CAPD patients. The left ventricular hypertrophy was similar between the two groups, we think the cause was that CAPD patients had lower serum albumin and higher proportion of diabetes, et al. The correlative analysis also found that the left ventricular hypertrophy had obvious positive correlation to volume overload and blood pressure. Water and salt restriction could decrease the left ventricular hypertrophy.
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