title: Heart failure in long-term peritoneal dialysis patients: a 4-year prospective analysis.
abstract: OBJECTIVE
  Heart failure occurs frequently in end-stage renal disease patients. However, there are no prospective, longitudinal follow-up data on its prevalence, severity, and risk factors in long-term peritoneal dialysis (PD) patients.
  
  
  METHODS
  A prospective observational study was conducted in 220 long-term PD patients followed up for 4 years or until death. Echocardiography was obtained at baseline. Primary study end points were heart failure and mortality.
  
  
  RESULTS
  Eighty-six patients had a previous history of heart failure at study entry. The cumulative 4-year survival probability was 37.4% and 64.7% for patients with and without previous heart failure, respectively (P<0.0001). During follow-up, 87 patients (40.9%) developed heart failure, of which 53 were recurrence and 34 were new-onset heart failure. Diabetes, background atherosclerotic vascular disease, systolic hypertension, left ventricular (LV) mass index, systolic dysfunction, and hypoalbuminemia were significant risk factors predicting heart failure in the entire cohort. Diabetes and LV mass and volume index were significant predictors of new-onset heart failure. Systolic hypertension, LV volume index, and hypoalbuminemia were significant predictors of recurrent heart failure.
  
  
  CONCLUSIONS
  Heart failure is a highly prevalent complication in long-term PD patients and predicts adverse clinical outcomes. More attention should be focused on improving BP and volume control and identifying treatment strategies that effectively lower atherosclerotic burden and reverse LV hypertrophy, remodeling, and systolic dysfunction in PD patients.
authors.affiliation: Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. aymwang@hku.hk
authors.forename: Angela Yee-Moon
authors.initials: AY
authors.lastname: Wang
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.forename: Christopher Wai-Kei
authors.initials: CW
authors.lastname: Lam
authors.forename: Iris Hiu-Shuen
authors.initials: IH
authors.lastname: Chan
authors.forename: Siu-Fai
authors.initials: SF
authors.lastname: Lui
authors.forename: John E
authors.initials: JE
authors.lastname: Sanderson
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors