Hemodialysis was linked to a decline in right ventricular function (RVFWLS) compared to peritoneal dialysis, with decreased RVFWLS raising mortality and heart failure risk (HR 4.181).
Does peritoneal dialysis compared to hemodialysis preserve right ventricular function and improve clinical outcomes in patients with end-stage renal disease?
In patients with end-stage renal disease, hemodialysis is associated with a progressive decline in right ventricular systolic function compared to peritoneal dialysis, and this decline strongly predicts heart failure hospitalization and mortality.
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Abstract Background End-stage renal disease patients face a heightened risk of cardiovascular disease and heart function impairment, leading to significant morbidity and mortality. This study aims to compare the effects of peritoneal dialysis (PD), compared with hemodialysis (HD) on cardiac function and clinical outcomes. Methods Subjects with end-stage renal disease, undergoing renal replacement therapy (RRT) were enrolled in this study. The participants would receive baseline and annual echocardiographic evaluations before and after RRT. Left ventricular global longitudinal strain (LVGLS) and right ventricular free wall longitudinal strain (RVFWLS) were assessed. Individuals with heart failure, atrial fibrillation, and significant valvular diseases were excluded. Clinical outcomes, including mortality and heart failure hospitalization (HHF) were followed. Result A total of 96 patients (63±14 years; 52.1% men) were analyzed, including 36 subjects in the PD group and 60 subjects in the HD group. In general, the HD subjects were older, more male-dominant, and had a higher prevalence of coronary artery disease (CAD). After RRT, significant reductions in left ventricular end-diastolic volume, LVGLS and RVFWLS was observed in HD group but not in PD group. After adjusting for age and sex, HD was associated with the reduction in RVFWLS compared with PD. The Kaplan-Meier curve analysis showed that a decreased RVFWLS was associated with higher HHF and mortality rates. The Cox regression analysis further demonstrated RVFWLS was independently correlated adverse clinical outcomes (hazard ratio per -1% decrease and 95% confident intervals: 4.181; 2.250-7.769), after accounting for age, gender, CAD, and serum albumin levels. Conclusion The study results suggested HD, compared with PD was associated progressive decline in LV and RV systolic functions, but better remodeling in LV chamber size. However, RV systolic function, indexed by RVFWLS was an essential determinant of the long-term outcomes in patients undergoing dialysis. These findings may contribute to better risk stratification and clinical management in this population.
Fu et al. (Sat,) reported a other. Hemodialysis was linked to a decline in right ventricular function (RVFWLS) compared to peritoneal dialysis, with decreased RVFWLS raising mortality and heart failure risk (HR 4.181).