Analysis of Left-Ventricular Changes Associated with Chronic Hemodialysis

Abstract

To assess the reasons for the frequent cardiovascular complications in patients with end-stage renal disease (ESRD), 61 out of 131 normotensive ESRD patients originally examined (mean ESRD duration: 71 ± 41 months) were followed over 2.5 years by echo-, electro- and mechanocardiography. Clinical and biochemical parameters were comparable. The prevalence of pericardial effusion (3%), pericardial thickening (14%), aortic valve sclerosis (14%) and mitral valve anulus sclerosis (12%) was unchanged. The interventricular septum diameter (14.3 ± 3.0 vs. 16.4 ± 3.4 mm), index of left-ventricular (LV) wall asymmetry (1.25 ± 0.30 vs. 1.52 ± 0.36) and left atrial diameter (38.3 ± 5.4 vs. 42.6 ± 3 mm) increased (p < 0.001). The LV end-systolic diameter decreased slightly (35.8 + 6.3 vs. 34.2 ± 6.4 mm; p < 0.05), with no significant changes for end-diastolic diameter (50.4 ± 6.3 vs. 49.3 ± 6.1 mm), muscle mass index (189 ± 57 vs. 197 ± 50 g/m²), stroke volume (86.1 ± 26.2 vs. 85.7 ± 26.7 7 ml/m²) and fractional shortening (29.1 ± 7 vs. 30.8 ± 8.6%). We conclude that the predominant finding in ESRD is an LV hypertrophy progressing towards an asymmetric septum hypertrophy, while the increase of the primarily enlarged left atrial diameter over 30 months reflects a further deterioration of the diastolic LV dysfunction.

Assessment of Risk Factors for Cardiovascular Complications in Patients with Chronic Kidney Disease (CKD) Stage III-V before Dialysis

“…39 Importantly, left ventricular growth is modifiable through treatment of hypertension and anaemia. 40 LVH rose proportionally to GFR decline reaching a value >50% in stage V. In the present study, we found LVH in 44.4% of patients in stage V by echocardiography and a slightly lower percentage (40.7%) by ECG. Our study also shows that, LVH increased proportionally from stage III-V with a statistically significant difference.…”

Ventricular Arrhythmias and Sudden Cardiac Death in End-Stage Renal Disease Patients on Chronic Hemodialysis

“…LVH in uremic patients is correlated with the BP, but is not completely explained by a high BP [22]. Even in HD patients with a normal predialysis BP, Hüting et al [23]documented an increase of the LV mass over 2 years despite the absence of hypertension. Using multivariate analysis, Harnett et al [24]showed that other factors such as chronic HD, age, and systolic BP were independent risk factors for LVH.…”

Echocardiographic findings in kidney transplanted Type 1 (insulin-dependent) diabetic patients with and without a pancreas transplant

“…The slight hypertrophy of the left ventricular wall which was recorded is probably an effect of longstanding hypertension and periods of fluid overload prior to the renal transplantation (Thuesen et al 1988;Htiting et al 1988;Sampson et al 1990). In spite of this almost inevitable experience in this disease, left ventricular systolic function was well preserved in all patients.…”