Left Ventricular Hypertrophy and Clinical Outcome in CAPD Patients

OBJECTIVE: To determine the clinical outcome of left ventricular hypertrophy (LVH) (left ventricular wall diastole thickness > or = 1.2 cm) detected by echocardiography in nondiabetic, 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.