title: Atrial electromechanical delay and left atrial mechanical functions in hemodialysis and peritoneal dialysis patients.
abstract: BACKGROUND
  Left atrium (LA) mechanical functions and atrial electromechanical delay (AEMD) times were considered independent predictors of cardiovascular morbidity in general population. Data are scant about these parameters in end-stage renal disease (ESRD) patients receiving hemodialysis (HD) and peritoneal dialysis (PD). We aimed to evaluate AEMD times and LA mechanical functions and associated risk factors in HD and PD patients.
  
  
  METHODS
  Forty-four healthy individuals, 62 HD and 50 PD patients were enrolled in the study. Echocardiography was performed before midweek dialysis session for HD patients and on admission for PD patients. Data were expressed as mean ± SD. Spearman's test was used to assess linear associations. Predictors of left intra-atrial EMD time and LA active emptying volume (LAaeV) were assessed by regression analysis.
  
  
  RESULTS
  Left intra-atrial-AEMD times were significantly longer in HD patients compared to PD patients. LAaeV was positively correlated with inter-atrial time, left intra-atrial time, systolic and diastolic BP, calcium and neutrophil-to-lymphocyte ratio (NLR) (r 0.22, p 0.016; r 0.28, p 0.002; r 0.34, p < 0.001; r 0.35, p < 0.001; r 0.37, p < 0.001; r 0.46, p < 0.001, respectively) and negatively correlated with serum uric acid (r -0.31, p 0.013) in ESRD patients. We found positive correlations between left intra-atrial time and LAaeV, LAVmax, LAVp and NLR (r 0.28, p 0.002; r 0.27, p 0.003; r 0.27, p 0.003; r 0.22, p 0.03, respectively) and negative correlations with albumin, uric acid and potassium (r -0.24, p 0.008; r -0.19, p 0.04; r -0.26, p 0.037, respectively). Advanced age, decreased serum albumin and increased NLR were found to be independent predictors of LAaeV; however, only NLR was found to be an independent predictor of AEMD time in this population.
  
  
  CONCLUSIONS
  Increased inflammation might be a risk factor of AEMD and LA mechanical dysfunction in ESRD patients.
authors.affiliation: Department of Internal Medicine, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Levent
authors.initials: L
authors.lastname: Demirtas
authors.affiliation: Division of Nephrology, Department of Internal Medicine, School of Medicine, Konya Necmettin Erbakan University, 42080, Konya, Turkey. ucmdkt@gmail.com.
authors.forename: Kultigin
authors.initials: K
authors.lastname: Turkmen
authors.affiliation: Department of Cardiology, Erzincan University Mengucek Gazi Training and Research Hospital, Erzincan, Turkey.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Buyuklu
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Kocyigit
authors.affiliation: Department of Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey.
authors.forename: Ozcan
authors.initials: O
authors.lastname: Orscelik
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016279:Atrial Function, Left; D001794:Blood Pressure; D002118:Calcium / Q000097:blood; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010530:Peritoneal Dialysis; D011188:Potassium / Q000097:blood; D006435:Renal Dialysis; D012709:Serum Albumin / Q000378:metabolism; D014527:Uric Acid / Q000097:blood
chemical_list: D012709:Serum Albumin; D014527:Uric Acid; D011188:Potassium; D002118:Calcium
keywords: Hemodialysis; Inflammation; Left atrium mechanical function; Left intra-atrial electromechanical delay time; Peritoneal dialysis