Left atrial enlargement is associated with a rapid decline in residual renal function in ESRD patients on peritoneal dialysis.
BACKGROUND
Left atrial (LA) volume index (LAVI) has been considered a stable indicator of diastolic dysfunction and an independent predictor of mortality in patients with end-stage renal disease. To date, however, little is known about the relationship between LA enlargement and the changes in residual renal function (RRF).


METHODS
This study was undertaken to investigate the association between LA enlargement and the decline in RRF in 121 incident peritoneal dialysis patients. Within 2 months after the initiation of peritoneal dialysis, LA enlargement was determined by echocardiography and RRF by 24-hour urine collection. Subsequently, RRF was measured every 6 months.


RESULTS
The rates of decline in RRF were significantly greater in patients with LA enlargement (LAVI > 32 mL/m(2)) compared with those without LA enlargement (-0.17 ± 0.18 vs -0.07 ± 0.16 mL/min/month/1.73 m(2), P = .002). In a linear mixed model, there was a significant difference in the rates of RRF decline over time between patients with and without LA enlargement (P < .001). Pearson's correlation analysis revealed that there were significant inverse correlations between the rates of the decline in RRF and LAVI (r = -0.22, P = .018). In multiple linear regression analysis adjusted for other risk factors, LAVI was found to be an independent determinant of the rates of decline in RRF (β = -0.026, P = .018).


CONCLUSIONS
This study shows that a higher LAVI is independently associated with a more rapid decline in RRF in patients with end-stage renal disease on peritoneal dialysis.
Department of Internal Medicine, College of Medicine, Severance Biomedical Science Institute, Brain Korea 21,Yonsei University, 134 Shinchon-Dong, Seodaemoon-Gu, Seoul, Korea.
Seung Jun
SJ
Kim
Hyung Jung
HJ
Oh
Dong Eun
DE
Yoo
Dong Ho
DH
Shin
Mi Jung
MJ
Lee
Jung Tak
JT
Park
Seung Hyeok
SH
Han
Tae-Hyun
TH
Yoo
Kyu Hun
KH
Choi
Shin-Wook
SW
Kang
D000328:Adult; D000368:Aged; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D014463:Ultrasonography