title: Left atrial volume is an independent predictor of mortality in CAPD patients.
abstract: 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/m(2)) 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/m(2) than those with LAVI ≤ 32 mL/m(2) (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.
authors: Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
authors: Seung Jun
authors: SJ
authors: Kim
authors: Seung Hyeok
authors: SH
authors: Han
authors: Jung Tak
authors: JT
authors: Park
authors: Jwa-Kyung
authors: JK
authors: Kim
authors: Hyung Jung
authors: HJ
authors: Oh
authors: Dong Eun
authors: DE
authors: Yoo
authors: Tae-Hyun
authors: TH
authors: Yoo
authors: Shin-Wook
authors: SW
authors: Kang
authors: Kyu Hun
authors: KH
authors: Choi
mesh_terms: D016279:Atrial Function, Left / Q000502:physiology*; D002306:Cardiac Volume; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011237:Predictive Value of Tests; D015996:Survival Rate