| Cardiovascular complication is an important reason of dropping out of peritoneal dialysis (PD),about 40% of those patients according to data from our centre.Its pathophysiologic mechanism has not been clear. Framingham based risk factors such as hypertension and hyperlipemia may contribute to the increased risk of cardiovascular death in patients on peritoneal dialysis,and other risk factors that are related to PD include volume status and micro-inflammation state may also play an important role in it.In this article, the objectiv is to investigate the change of Cardiac function and construct,analyse the risk factors in peritoneal dialysis and provide the basis for reducing these complications.Part One Changes of cardiothoracic ratio and its relative factors in peritoneal dialysis patientsObjective:To investigate the change of cardiothoracic ratio and its risk factors in peritoneal dialysis(PD).Methodology:In this prospective study, one hundred and twenty-three patients which received peritoneal dialysis(PD) from June 2010 to December 2011 were enrolled,excluding patients with acute kidney injury.The album, hemoglobin (Hb),blood pressure,body mass index(BMI),urine volume, ultrafiltration,fluid removal,residual glomerular filtration rate (rGFR),Urea Kt/V,creatinine clearance (Ccr) were examined during the follow up.Simultaneously,cardial function and construct were observed by echocardiography and chest radiograph every 6 month in all patients, to explore dynamic changes of all indexes and risk factors of cardiothoracic ratio.Results:(1)With the extending of time on PD treatment,CTR was gradually increasing.CTR was 0.465±0.04、0.474±0.045、0.492±0.060(P<0.01)on pre-PD,and six,twelve months after PD in all patients,and ejection fraction (EF) presented the downward trend.(2) Swollen,chest distress,blood pressure significantly increasing and other clinical manifestation of cardia insufficiency have presented in twenty patients. Diabetic nephropathy was in 7 (35%), refractory hypertension in 16 (80%), continuous ambulatory peritoneal dialysis in 8 cases (40%),and these patients were with serious Anemia and rapid decline of rGFR.(3)Correlation and Regression analysis revealed that BMI(r=0.375,β=0.442), SBP(r=0.281,p=0.217),Hb(r=-0.283,β=-0.199), fluid removal(r=-0.231,β=-0.851)were independent factors for CTR.(4) With different degrees of residual renal function, CTR have changed.The records were divided into three groups according to RRF,<3ml/(min·1.73m2),3-6 ml/(min·1.73m2),>6ml/(min·1.73m2),CTRwas 0.493±0.062,0.468±0.043,0.456±0.042 (P<0.05).Conclusion:With the extending of time on PD treatment, cardiac structure and function was changed, which related to volume overload by PD itself, meanwhile, BMI,SBP,Hb,rGFR,fluid removal have also significantly correlated with it.Part Two Study on cardiovascular complications in different peritoneal dialysis modeObjective:To investigate cardiovascular complications in different peritoneal dialysis mode.Methodology:In this prospective study,the patients which received peritoneal dialysis(PD) from June 2010 to December 2010 were enrolled and randomized into group 1 and group 2. Patients in group 1 were treated with CAPD by using the dialysate 6-8L/day, and peritoneal dialysate left in abdomen cavity at night. Patients in group 2 were treated with DAPD by using the dialysate 6-8L at daytime, and evacuate of dialysate from abdomen at night. The observation parameters was compared between the two groups,including the incidence rate,time and prognosis of congestive heart failure,malignant hypertension and some other cardiovascular complication. Cardiac function and construct were observed by echocardiography and chest radiograph every 6 month in all patients, to investigate dynamic changes of cardiothoracic ratio, left ventricular internal diameter, left atrial diameter, left ventricular wall thickness, right ventricular diameter, interventricular septal thickness and so on, meanwhile blood pressure,dialysis adequacy and residual glomerular filtration rate was also included.Results:(1) 64 patients was enrolled in this study.1,2-year of CHF incidence rate was 16%,28% in group l,and the incidence rate of group 2 was 6%,13%(P<0.05). With the extending of time on PD treatment, incidence rate was gradually increasing. (2)The CTR have no difference between two groups at baseline,but at the end of follow-up the CTR of group 1 and 2 were 0.51±0.04,0.48±0.05(P<0.05). left ventricular internal diameter of group 1 and 2 were 52.66±6.49 mm,48.69±4.70mm,and there is a significant difference (P<0.05). (3)At the end of follow-up,blood pressure<140/90mmHg as a standards, the compliance rate of BP was 54.2% vs 84.8% in group 1 and 2 (P<0.05), the rate of group 1 was significantly lower than group 2.(4)Dialysis adequacy has no difference in two groups.Conclusion:The incidence rate of cardiovascular complication is lower in DAPD patients,and the change of cardiothoracic ratio is little,which may relate to volume status and residual renal fuction. |
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