Clinical Outcomes after CAPD in End Stage Renal Disease Patients with Severe LV Systolic Dysfunction

Park, Jin Young; Song, Joon Ho; Lee, Seoung Woo; Kim, Il Gwon; Kim, Moon Jae

Abstract

BACKGROUND: Continuous ambulatory peritoneal dialysis(CAPD) is known to be a relatively effective in decreasing the cardiac loading and improving the symptoms and survivals in the patients with severe left ventricular(LV) dysfunction, who are refractory to conventional medical treatments.
METHODS
We reviewed retrospectively the clinical course and prognosis of 18 patients initiating CAPD and manifesting severe LV dysfunction at the same from September, 1996 to December, 2000 in Inha University Kidney Center. To know the effect of LV dysfunction on the survival, the outcomes of 103 CAPD patients with normal cardiac function was compared as control group.
RESULTS
Total subjects were 11 male and 7 female with a mean age of 59.9+/-1.6 years. Causes of end stage renal disease were diabetic nephropathy (12), chronic glomerulonephritis(1), lupus nephritis(1), and unknown(2). Mean follow-up duration was 12.7+/-10.6 months. In pre-CAPD period, all subjects showed cardiac symptoms of NYHA class III or IV with a mean ejection fraction of 27.6+/-0.6%. Six months after CAPD, mean ejection fraction of all patientswas improved up to 44.8+/-3.1%. 13 patients(72.2%) showed improvement of cardiac function in terms of NYHA class. Five patients showed neither improvement nor aggravation of cardiac function, who were mostly female, older, and transferred from hemodialysis and three of whom died. During follow-up period, seven patients died because of aggravation of previous cardiac disease(4), acute myocardial infraction(1), cerebral hemorrhage(1) and peritonitis(2). When compared to 103 patients without LV dysfunction who started CAPD, 1-year survival was poorer in the patients with LV dysfunction(41.7% vs 77.8%, p<0.05).
CONCLUSION
LV dysfunction is still a risk factor of poor survival, CAPD may improve symptoms and systolic cardiac fucntion in ESRD patients with severe LV dysfunction.