Left Ventricular Dysfunction in End-Stage Renal Disease: Echocardiographic Insights

London, Gérard M.; Fabiani, F

doi:10.1007/978-1-4615-3902-5_8

Cited by 21 publications

(32 citation statements)

References 59 publications

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“…There are several possible hemodynamic and metabolic reasons for the relationship between LVH and chronic HD [28,29]. One potential mechanism is the increased cardiac workload secondary to the effect of the a-v fistula/graft.…”

Section: The Distribution Of Patients By Percentile Of Lvm Index Is Smentioning

confidence: 99%

Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors

Mitsnefes

Daniels

Schwartz

et al. 2000

Pediatric Nephrology

198

135

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Left ventricular hypertrophy (LVH) has been recognized as an independent risk factor for cardiovascular morbidity and mortality in adults with end-stage renal disease. However, the prevalence and severity of LVH in children on chronic dialysis therapy is not well established. Retrospectively, 64 chronic dialysis patients, aged 20 months to 22 years, on chronic dialysis had echocardiographic evaluation of LV mass (LVM) and geometry. Forty-eight (75%) children had LVH, including 22 of 26 (85%) on hemodialysis (HD) and 26 of 38 (68%) on peritoneal dialysis (PD). The prevalence of LVH in patients on HD was significantly higher than those on PD (P=0.02). Abnormal LV geometry was found in 51 of 64 (80%) patients: 25 patients (39%) had eccentric hypertrophy, 3 (5%) had concentric remodelling, and 23 (36%) had concentric LVH. Twenty-six children (41%) had severe LVH, defined as LVM index greater than 51 g/m2.7, which is associated with a fourfold greater risk for development of cardiovascular disease in adults. Patients with severe LVH had a significantly lower hemoglobin level (P=0.027) and longer duration of renal disease prior to the start of dialysis therapy (P=0.003) than patients without LVH. Multiple logistic regression analysis revealed HD as opposed to PD as a significant independent predictor for severe LVH (P=0.036). Higher systolic blood pressure remained in the final model as an independent predictor with a borderline level of significance (P=0.065). The results indicate that severe LVH and abnormal left ventricular geometry are common in young dialysis patients. Better control of blood pressure, anemia, and hypervolemia may be important in prevention or improving LVH.

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Section: The Distribution Of Patients By Percentile Of Lvm Index Is Smentioning

confidence: 99%

Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors

Mitsnefes

Daniels

Schwartz

et al. 2000

Pediatric Nephrology

198

135

View full text Add to dashboard Cite

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“…It was shown in 25-87% of predialysis patients and 50-97% of dialysis patients. [17][18][19][20][21][22][23][24] There is no agreement about the frequency of LVH geometric models in ESRD. While most studies demonstrate a predomination of cLVH (40-63% versus 20-30% of ecLVH), [20,24,25] some authors report the higher prevalence (63-79.6%) ecLVH.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Risk Factors of Myocardial Remodeling in Hemodialysis Patients

et al. 2009

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Background. Left ventricular hypertrophy (LVH) is an independent risk factor for morbidity/mortality in patients with end stage renal disease (ESRD). Our study aimed to identify prevalence as well as independent risk factors that contribute to the development of LV geometric remodeling in our HD patients. Methods. The left ventricles of 116 HD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. Furthermore, we measured inferior vena cava (IVC) diameter and its collapsibility index (CI) by echocardiography. Finally, we modeled a stepwise multiple regression analysis to determine the predictors of LV geometry. Results. Our study provides evidence that HD patients had a prevalence of abnormal LV geometry in 92% and LVH in 81%. We found all four geometric models of LV. Most dominant were eccentric LVH. Concentric LVH was observed in 37, normal geometry (NG) in 9, and concentric remodeling (CR) in 13 of HD patients. Mean arterial blood pressure was significantly higher in the cLVH group (95 ± 10 mmHg) than in the NG and CR groups (81.6 ± 12.3 and 80 ± 11.8, respectively, p < 0.001). The cLVH and eCLVH groups had significantly lower mean hemoglobin (10.3 ± 1.4g/dL and 10.6 ± 1g/dL, respectively) compared with the NG group (11.9 ± 1.4g/dL), p < 0.001. Furthermore, interdialytic weight gain (kg) was significantly higher in eCLVH group (3.13 ± 0.8) than in NG group (2.3 ± 1.1), p < 0.001. Mean IVC index of the eLVH group (10.83 ± 2.07 mm/m 2 ) was significantly higher than corresponding indexes of NG (10.83 ± 2.07 mm/m 2 ), CR (8.31 ± 1.32 mm/m 2 ) and cLVH (8.12 ± 2.06 mm/m 2 ) groups (p < 0.001 for each comparisons). Conclusion. Mean arterial pressure, hemoglobin, IVC index, and interdialytic weight gain were found to be independent predictors of LV geometry (R 2 = 0.147; p < 0.001) in HD patients.

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“…Autoregulation is not the only mechanism which can increase TPR. An Hypertension increases the severity and incidence of left ventricular hypertrophy [12,13] and atherosclerosis alternative view is that volume expansion increases the plasma Na/K-ATPase inhibitory activity due to release [14], implying that the treatment of hypertension and the maintenance of a normal BP are mandatory in ESRD of ouabain or ouabain isomer [15]. This inhibitor acts on renal tubules as well as on non renal tissue, such as vascular patients.…”

Section: Pathophysiologymentioning

confidence: 99%

Hypertension in Dialysis Patients

Bellinghieri

Santoro²,

Mazzaglia³

et al. 1999

Mineral Electrolyte Metab

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Hypertension is a major risk for cardiovascular complications in dialysis patients. The pathogenesis of hypertension is multifactorial and is not completely understood. Hypervolemia has always been considered a major pathogenetic factor. In addition, a disturbed hormone profile with an activated renin angiotensin system, increased catecholamine, vasopressin and endothelin, and perhaps decreased nitrous oxide activity seem to play a role in the high incidence of hypertension in dialysis patients. The influence of autonomic dysfunction on blood pressure control in hemodialysis patients is not clear. The frequent use of erythropoietin during the last decade may have contributed to the increased incidence of hypertension in the dialysis population. Data from the First Report on Dialysis and Transplant in Sicily showed that hypertension is the cause of end-stage renal disease in 8% of dialysis patients and that the incidence of hypertension, as a cause of end-stage renal disease, increased with age.

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Left Ventricular Dysfunction in End-Stage Renal Disease: Echocardiographic Insights

Cited by 21 publications

References 59 publications

Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors

Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors

Prevalence and Risk Factors of Myocardial Remodeling in Hemodialysis Patients

Hypertension in Dialysis Patients

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