title: Low calcium dialysate increases cardiac relaxation in CAPD patients.
abstract: OBJECTIVE
  To establish whether changes in serum calcium affect left ventricular (LV) function in continuous ambulatory peritoneal dialysis (CAPD) patients.
  
  
  METHODS
  This study was conducted on 28 clinically stable CAPD patients (11 females, 17 males). Left ventricular relaxation and systolic function were echocardiographically examined in all patients during standard dialysate (containing 1.75 mmol/L calcium) treatment. All patients were then changed to low calcium dialysate (1.25 mmol/L calcium) for 1 month and all patients were re-examined echocardiographically. Decrement in isovolumic relaxation time (IVRT) and deceleration time (DT), and increment in the ratio of peak early to peak late diastolic velocities (E/Amax) were admitted as indexes showing improvement in LV relaxation. 17 age- and sex-matched controls were also echocardiographically examined.
  
  
  RESULTS
  Deceleration time, interventricular septal thickness at systole (IVSTS) and diastole (IVSTD), and posterior wall thickness at systole (PWS) and diastole (PWD) were higher in CAPD patients using standard dialysate than in normal controls. With the use of low calcium dialysate, DTs were similar but IVSTS, IVSTD, PWS, and PWD values remained higher. In normal controls, E/Amax values were higher than those in CAPD patients using standard dialysate (p < 0.001) and low calcium dialysate (p = 0.009). Serum intact parathyroid hormone level, weight, clinical volume status, and blood pressure were similar throughout the study period. Serum ionized calcium levels were decreased significantly during low calcium dialysate treatment. The changes in IVRT, DT, and E/Amax suggest improvement in LV relaxation during low calcium dialysate treatment.
  
  
  CONCLUSIONS
  Left ventricular relaxation is increased with the use of low calcium dialysate compared with standard dialysate treatment. The idea of possible beneficial effects of increment in LV relaxation on cardiovascular morbidity and mortality deserves further studies.
authors.affiliation: Division of Nephrology, Department of Medicine, Akdeniz University, Antalya, Turkey. muratep@hotmail.com
authors.forename: Murat
authors.initials: M
authors.lastname: Tuncer
authors.forename: Cengiz
authors.initials: C
authors.lastname: Ermiş
authors.forename: Gültekin
authors.initials: G
authors.lastname: Süleymanlar
authors.forename: Gülşen
authors.initials: G
authors.lastname: Yakupoglu
authors.forename: F Fevzi
authors.initials: FF
authors.lastname: Ersoy
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood* / Q000494:pharmacology* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D015314:Dialysis Solutions / Q000737:chemistry / Q000494:pharmacology* / Q000627:therapeutic use; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D015314:Dialysis Solutions; D002118:Calcium