Key result
One year of PD shows improved global work efficiency in non-diabetic versus diabetic kidney disease.
Why the study?
Initiation of dialysis poses new cardiovascular challenges in ESKD, and the prognostic value of assessing LV myocardial function in peritoneal dialysis patients remains unclear.
Does peritoneal dialysis differentially affect left ventricular myocardial work indices in ESKD patients with diabetic versus non-diabetic kidney disease over 1 year?
Does peritoneal dialysis differentially affect left ventricular myocardial work indices in ESKD patients with diabetic versus non-diabetic kidney disease over 1 year?
Peritoneal dialysis improves left ventricular myocardial function in ESKD patients with non-diabetic kidney disease, but this benefit is attenuated in those with diabetic kidney disease.
Differential improvement in myocardial work efficiency after peritoneal dialysis by kidney disease type should not yet guide therapy; leaves open diabetes-specific cardiac effects for further study.
Introduction: Initiation of dialysis encompasses new cardiovascular challenges on patients with end-stage kidney disease (ESKD). The prognostic value of assessment of left ventricular (LV) myocardial function in peritoneal dialysis (PD) patients is still unclear. This study used global LV myocardial work (MW) indices to investigate the change of LV myocardial function undergoing PD within 1 year. Methods: A total of 179 patients with ESKD were enrolled in this prospective study. Among them, 48 patients were diagnosed with diabetic kidney disease (DKD) and 131 patients were non-diabetic kidney disease (NDKD). We evaluated LV myocardial function of patients with ESKD by two-dimensional speckle-tracking echocardiography (2D-STE) with strains and MW indices. Echocardiography and clinical data were evaluated at baseline and 1 year after PD. Results: Compared with NDKD group, patients with DKD had lower global longitudinal strain (GLS) (14.43±3.52 vs. 16.78±4.78 p=0.002), global work index (GWI) (1546.29±496.06 vs. 1750.51±416.97 p=0.006), and global constructive work (GCW) (1955.33±483.86 vs. 2129.65±459.04 p=0.028). After PD therapy, the NDKD group showed significant reduction of GWI (1616.78±360.18 vs. 1750.51±416.97 p＜0.001), GCW (1980.45±385.82 vs. 2129.65±459.04 p=0.006), and global wasted work (GWW) (158.00(102.00, 219.00) vs. 185.00(141.00, 250.00) p＜0.001) and increase of global work efficiency (GWE) (92.00(89.00, 94.00) vs. 91.00 (88.00, 93.00) p=0.008). Compared with NDKD group, the DKD group had less decrease of GWW (-14.00(-69.75, 85.00) vs. -36.00(-97.00, 21.00) p=0.020) and less increase of GWE (-1.00 (-4.00, 2.00) vs. 1.00(-2.00, 4.00) p=0.006) after PD therapy. After multivariable adjustment, Δresidual GFR (β=-0.165; p=0.034) and ΔDBP (β=-0.168; p=0.028) was the significant independent determinants of ΔGWE. ΔDBP was the only significant independent determinants of ΔGWW (β=0.343; p<0.001). Conclusion: After one year of PD treatment, patients with NDKD showed improved LV myocardial function. However, the benefit for DKD patients was relatively limited, reflected in a smaller increase in GWE and a smaller reduction in GWW.
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Wan et al. (2026) studied this question. After one year of peritoneal dialysis, patients with non-diabetic kidney disease showed improved global work efficiency compared to those with diabetic kidney disease.
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