Long-Term Evolution and Changing Associations of Left Ventricular Hypertrophy after Starting HemodialysisTakeda A.a · Toda T.a · Iwamoto H.b · Watanabe K.c · Matsui N.a
aKidney Center, Tsuchiura Kyodo General Hospital, bIwamoto Clinic, and cWatanabe Naika Clinic, Ibaraki, Japan
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Background/Aims:Left ventricular hypertrophy (LVH) is prevalent in dialysis patients and is recognized as a potent risk factor for cardiovascular diseases. We examined the evolution of LVH after starting dialysis and the determinants of changes in LV mass. Methods: A cohort of 107 patients who had two or more echocardiograms at yearly intervals after starting hemodialysis was studied. Results: At baseline, the mean LV mass index (LVMI) was 145.8 g/m2 and 73 (68%) patients had LVH. During the mean follow-up period of 34.5 months, LVMI decreased by 3.9 g/m2. At last follow-up, the mean LVMI was 141.5 g/m2 and 68 (64%) patients had LVH. For changes in LVMI, a significant correlation was found in changes in systolic blood pressure, LVMI at baseline, changes in serum albumin concentration, and age. The relationship between changes in LVMI and systolic blood pressure was close during the 1st and 2nd intervals, but became weak gradually during the 3rd and 4th intervals. Conclusion: Many patients had LVH at starting hemodialysis and continued to have LVH thereafter. The most important determinants of LV mass changes were baseline LV mass and systolic blood pressure control, but the grade of reduction decreased gradually with time. These results suggest that active antihypertensive treatment should be started early to regress LVH and prevent cardiovascular diseases.
© 2008 S. Karger AG, Basel
- Akiba T, Nakai S, Shinzato T, Kitaoka T, Kubo K, Maeda K: Why has the gross mortality of dialysis patients increased in Japan? Kidney Int 2000;57(suppl 74):S60–S65.
- Collins AJ, Li S, Gilbertson DT, Liu J, Chen SC, Herzog CA: Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int 2003;64(suppl 87):S24–S31.
- Zoccali C, Benedetto FA, Mallamaci F, et al: Prognostic impact of the indexation of left ventricular mass in patients undergoing dialysis. J Am Soc Nephrol 2001;12:2768–2774.
- Foley RN, Parfrey PS, Harnett JD, et al: Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 1995;47:186–192.
- Zoccali C, Benedetto FA, Mallamaci F, et al: Prognostic value of echocardiographic indicators of left ventricular systolic function in asymptomatic dialysis patients. J Am Soc Nephrol 2004;15:1029–1037.
London GM, Marchais SJ, Guérin AP, Fabiani F, Métivier F: Cardiovascular function in hemodialysis patients; in Grünfeld JP, Bach JF, Funck-Brentano JL, Maxwell MH (eds): Advances in Nephrology. St. Louis, Mosby-Year Book, vol 20, 1991, pp 249–273.
London GM, Marchais SJ, Guerin AP, Metivier F, Pannier B: Cardiac hypertrophy and arterial alterations in end-stage renal disease: hemodynamic factors. Kidney Int 1993;41(suppl 41):S42–S49.
- Harnett JD, Kent GM, Barre PE, Taylor R, Parfrey PS: Risk factors for the development of left ventricular hypertrophy in a prospectively followed cohort of dialysis patients. J Am Soc Nephrol 1994;4:1486–1490.
- Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE: Serial change in echocardiographic parameters and cardiac failure in end stage renal disease. J Am Soc Nephrol 2000;11:912–916.
- London GM, Pannier B, Guerin AP, et al: Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol 2001;12:2759–2767.
- Zoccali C, Benedetto FA, Mallamaci F, et al: Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression. Kidney Int 2004;65:1492–1498.
- Devereux RB, Reichek N: Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1977;55:613–618.
- Pombo JF, Troy BL, Russell RO Jr: Left ventricular volumes and ejection fraction by echocardiography. Circulation 1971;43:480–490.
- Levy D, Savage DD, Garrison RJ, et al: Echocardiographic criteria for left ventricular hypertrophy. The Framingham Study. Am J Cardiol 1987;59:956–960.
- Cannella G, Paoletti E, Barocci S, et al: Angiotensin-converting enzyme gene polymorphism and reversibility of uremic left ventricular hypertrophy following long-term antihypertensive therapy. Kidney Int 1998;54:618–626.
- Paoletti E, Cassottana P, Bellino D, Specchia C, Messa P, Cannella G: Left ventricular geometry and adverse cardiovascular events in chronic hemodialysis patients on prolonged therapy with ACE inhibitors. Am J Kidney Dis 2002;40:728–736.
- Chan CT, Floras JS, Miller JA, Richardson RMA, Pierratos A: Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int 2002;61:2235–2239.
- Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE: Long term evolution of cardiomyopathy in dialysis patients. Kidney Int 1998;54:1720–1725.
- Goodman WG, London G, Amann K, et al: Vascular calcification in chronic kidney disease. Am J Kidney Dis 2004;43:572–579.
- Davies MR, Hruska KA: Pathophysiological mechanisms of vascular calcification in end-stage renal disease. Kidney Int 2001;60:472–479.
- Koenig W, Sund M, Fröhlich M, et al: C-reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (monitoring trends and determinants in cardiovascular disease) Augsburg Cohort Study, 1984 to 1992. Circulation 1999;99:237–242.
- Park CW, Shin YS, Kim CM, et al: Increased C-reactive protein following hemodialysis predicts cardiac hypertrophy in chronic hemodialysis patients. Am J Kidney Dis 2002;40:1230–1239.
- Kaysen GA, Dubin JA, Muller HG, Rosales L, Levin N, Mitch WE: Inflammation and reduced albumin synthesis associated with stable decline in serum albumin in hemodialysis patients. Kidney Int 2004;65:1408–1415.
- Beddhu S, Pappas LM, Ramkumar N, Samore MH: Malnutrition and atherosclerosis in dialysis patients. J Am Soc Nephrol 2004;15:733–742.
- Iseki K, Miyasato F, Tokuyama K, et al: Low diastolic blood pressure, hypoalbuminemia, and risk of death in a cohort of chronic hemodialysis patients. Kidney Int 1997;51:1212–1217.
- Zager PG, Nikolic J, Brown RH, et al: ‘U’ curve association of blood pressure and mortality in hemodialysis patients. Kidney Int 1998;54:561–569.
- Port FK, Hulbert-Shearon TE, Wolfe RA, et al: Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. Am J Kidney Dis 1999;33:507–517.
- Peranzella MA: Approach to patients with intradialytic hypotension: a focus on therapeutic options. Semin Dial 1999;12:175–181.
- Horl MP, Horl WH: Hemodialysis-associated hypertension: pathophysiology and therapy. Am J Kidney Dis 2002;39:227–244.
- Takeda A, Toda T, Fujii T, Shinohara S, Sasaki S, Matsui N: Discordance of influence of hypertension on mortality and cardiovascular risk in hemodialysis patients. Am J Kidney Dis 2005;45:112–118.
- Takeda A, Toda T, Fujii T, Sasaki S, Matsui N: Can predialysis hypertension prevent intradialytic hypotension in hemodialysis patients? Nephron 2006;103:137–143.
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