Comparative cardiac effects of hemodialysis and continuous ambulatory peritoneal dialysis

Abstract

To assess the comparative cardiac effects of hemodialysis and continous ambulatory peritoneal dialysis (CAPD), we performed M-mode echocardiography prior to and immediately following hemodialysis on 56 patients and during the dwell phase of CAPD on 39 patients. Hemodialysis produced a significant increse in the mean velocity of circumferential fiber shortening (V̄CF, an index of left ventricular systolic function) in patients with low V̄CF prior to dialysis, but resulted in no significant change in V̄CF in patients with normal predialysis V̄CF. Hemodialysis produced a significant increase in V̄CF in patients with a normal predialysis left ventricular end-diastolic volume index (LVEDVI), but resulted in no significant change in V̄CF in patients with left ventricular dilatation prior to dialysis. Hemodialysis produced a significant decrease in mean LVEDVI and mean stroke index, but resulted in no significant change in mean cardiac index due to a reflex increase in heart rate. Mean LVEDVI, mean stroke index, and V̄CF values in patients on CAPD were not significantly different from those observed immediately following hemodialysis. Mean cardiac index and mean heart rate were significantly lower in CAPD patients than in posthemodialysis patients. Pericardial effusion was observed in 25% of hemodialysis patients and 5% of CAPD patients (p<0.05). We conclude (1) the effects of hemodialysis on left ventricular performance are variable and depend in part on predialysis left ventricular volume and left ventricular systolic function, (2) except for a lower cardiac index, left ventricular hemodynamics for CAPD patients resemble those of posthemodialysis patients, and (3) pericardial effusion occurs with significantly higher frequency in patients on hemodialysis than in those on CAPD.