Left atrial volume is an independent predictor of mortality in CAPD patients

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2011-11, Vol.26 (11), p.3732-3739
• Main Authors: Kim, Seung Jun, Han, Seung Hyeok, Park, Jung Tak, Kim, Jwa-Kyung, Oh, Hyung Jung, Yoo, Dong Eun, Yoo, Tae-Hyun, Kang, Shin-Wook, Choi, Kyu Hun
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atrial Function, Left - physiology; Biological and medical sciences; Cardiac Volume; Cohort Studies; Echocardiography; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Glomerular Filtration Rate; Glomerulonephritis; Humans; Intensive care medicine; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - physiopathology; Kidney Function Tests; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Peritoneal Dialysis, Continuous Ambulatory; Predictive Value of Tests; Survival Rate
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfr118

Background. Echocardiography is an established technique to estimate the risk for cardiovascular complications in patients with end-stage renal disease (ESRD). An enlarged left atrium (LA) has recently emerged as a marker of adverse cardiovascular outcomes in various pathologic conditions. However, there have been few studies to evaluate its prognostic value in patients with ESRD, particularly those receiving continuous ambulatory peritoneal dialysis (CAPD). Methods. We conducted an observational cohort study to investigate whether enlarged LA can predict patient outcome in 216 patients with CAPD. Study outcomes were all-cause and cardiovascular mortality. Results. Increased left atrium volume index (LAVI > 32 mL/m2) was observed in 99 (45.8%) of the CAPD patients. During the follow-up (26.3 ± 18.6 months), 20 patients (9.3%) died. Kaplan-Meier analysis revealed that the 5-year survival rate was significantly lower in patients with LAVI > 32 mL/m2 than those with LAVI ≤ 32 mL/m2 (69 versus 82%, P = 0.024). In multivariate analyses adjusted for echocardiographic parameters and clinical and laboratory data, increased LAVI was an independent predictor of all-cause mortality [hazard ratio (HR) 1.05, 95% confidence interval (CI) 1.01-1.10, P = 0.03] and cardiovascular mortality (HR 1.08, 95% CI 1.02-1.14, P = 0.006). Furthermore, increased LAVI provided the highest predictive value for all-cause mortality [area under the receiver operating characteristic curve (AUC) = 0.766, P < 0.001] and cardiovascular mortality (AUC = 0.836, P < 0.001) among the measured echocardiographic parameters. Conclusions. We showed that increased LAVI predicted adverse outcomes better than other echocardiographic parameters in patients with CAPD.