A study on correlation of anemia with left ventricular hypertrophy in chronic kidney disease patients: a cross sectional study from Southern Rajasthan

Abstract

Background: Chronic kidney disease is becoming epidemic of twenty-first century. With increasing burden of diabetes and hypertension, chronic kidney disease is becoming rampant in our country. Adverse outcome of CKD includes kidney failure, complications due to decreased kidney function and cardiovascular disease etc. Increasing morbidity and mortality of coronary artery disease in CKD patients make it necessary to develop further researches in these population. Aim and objectives of current study were to demonstrate the correlation of anemia with left ventricular hypertrophy in a cohort of CKD patients in a tertiary care centre.Methods: This study was done over one year on 100 patients of CKD (stage III to V), aged 15-80 years, who had elevated serum creatinine and reduced glomerular filtration rate, haemoglobin <11 gm/dl with ultrasonographic evidence of renal parenchymal disease grade >2. The patients were assessed based on clinical history and a number of laboratory parameters including blood urea, serum creatinine, calcium, inorganic phosphorus, serum electrolytes, iPTH level, Hb, Hct, glomerular filtration rate and left ventricular mass index.Results: There is a significant relationship between of anemia and left ventricular hypertrophy among chronic kidney disease patients. In our study, it was observed that left ventricle mass (left ventricular mass index) increases with increasing severity of anemia.Conclusions: Anemia is widely prevalent in our CKD patients. Severity of anemia is correlated to left ventricular hypertrophy in these patients. Hence correction of anemia early in these group of patients can halt or prevent cardiovascular morbidity and mortality.

Left ventricular hypertrophy (LVH) in different stages of chronic kidney disease (CKD) patients and its correlation with anaemia

“…49% of the male cases had increased left ventricular mass according to Devereux formula. 7 In our study, there is association male groups had increased left ventricular mass. More patients with severe left ventricular hypertrophy were found in stage 5 of CKD in female and male which was 8 and 23 respectively.…”

“…In fact the role of anemia as a cardiac risk factor was shown in an evaluation of 246 patients in which it was found that every 0.5 g/dl decrease in Hb increased the relative risk of left ventricular growth by 32% (p=0.04).5 Also in a prospective study of recombinant erythropoietin use in pre-dialysis patients; increase in mean Hb of 2.7 g/dl was accompanied by a decrease in left ventricular mass index (left ventricular mass index) in almost all patients. 7 This even in the absence of improved blood pressure control, confirmed the role of anemia in the genesis of left ventricular hypertrophy.…”

“…Moreover, various studies done over the years have shown not only a higher incidence of anemia, but also a significantly higher incidence of cardiac complications, particularly left ventricular hypertrophy in chronic kidney disease patients. 7 In chronic kidney disease patients, various uremia related risk factors for cardiovascular disease includes anemia, hyperparathyroidism, abnormalities of mineral metabolism, acidosis, of note, association of anemia have been consistently described in all population of kidney disease. Anemia is defined as decrease in either percentage of RBC (hematocrit) or decrease in haemoglobin concentration in sample of venous blood when compared to reference values.…”

“…Anemia has been cited as an independent risk factor for the development of left ventricular hypertrophy (left ventricular hypertrophy) in chronic kidney disease patients. 7 Anemia leads to hemodynamic as well as non hemodynamic adaptation. Nonhemodynamic adaptation includes increase in erythropoietin hormone and intraerythrocytic 2,3 DPG.…”

Pathophysiological concepts and screening of cardiovascular disease in dialysis patients

“…Left ventricular hypertrophy (LVH) in dialysis patients is a complex physiologic adaptive response to long-term increase in volume or pressure load (31). It is not an uncommon complication among pre-dialysis patients with CKD (32,33). LVH is prevalent in up to 75% of CKD patients at initiation of dialysis (34).…”