Left Ventricular Hypertrophy and Clinical Outcome in CAPD Patients

Abstract

Objective To determine the clinical outcome of left ventricular hypertrophy (LVH) (left ventricular wall diastole thickness ≥ 1.2 cm) detected by echocardiography in non-diabetic, continuous ambulatory peritoneal dialysis (CAPD) patients without dilated cardiomyopathy. Design A prospective, descriptive study was conducted between 1 July 1995 and 31 January 1998. Patients were followed up for 24 months. Setting Peritoneal dialysis unit in a medical school hospital. Patients and Methods Baseline and yearly echocardiograms were carried out on 66 patients receiving CAPD. Cardiac death was assessed. LVH was correlated with outcome. Results Of 66 nondiabetic CAPD patients without dilated cardiomyopathy, 20 had a normal echocardiogram (LV wall thickness < 1.2 cm), 21 had mild hypertrophy, and 25 severe hypertrophy (LV wall thickness > 1.4 cm in diastole). In the first two groups, 21% were admitted with congestive heart failure (CHF) after starting dialysis. The 1-year cumulative survival was 85% among those with mild hypertrophy and 91% in the normal group. In the group with severe hypertrophy, 57% were admitted at least once with CHF, and the 1-year cumulative survival was 56%. Eighty-two percent of those who died in the severe group, which accounted for the significantly worse survival ( p = 0.003), died from cardiac or cerebrovascular causes, compared with none of those with a normal echocardiogram. Conclusions Severe LVH was found in a third of our CAPD patients and was associated with a significantly high cardiovascular morbidity and mortality.