Left Ventricular Mass in Dialysis Patients, Determinants and Relation with Outcome. Results from the COnvective TRansport STudy (CONTRAST)

Mostovaya, Ira M.; Bots, Michiel L.; Dorpel, Marinus A. van den; Goldschmeding, Roel; Hoedt, Claire H. den; Kamp, Otto; Lévesque, Renée; Mazairac, Albert H.A.; Penne, E. Lars; Swinkels, Dorine W.; Weerd, Neelke C. van der; Wee, Piet M. ter; Nubé, Menso J.; Grooteman, Muriël P.C.

doi:10.1371/journal.pone.0084587

Cited by 30 publications

(26 citation statements)

References 39 publications

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“…Previously, we showed that patients with a high LVM are at increased risk for all-cause mortality, cardiovascular mortality and sudden death [15]. These findings were confirmed in the present investigation.…”

Section: Discussionsupporting

confidence: 91%

“…Given this high occurrence rate, identification of risk factors for sudden death and, thus possibly, opportunities for preventive interventions seem highly required. As LVH is a well-established risk factor for all-cause and cardiovascular mortality and, particularly, for sudden cardiac death [15], the question arises whether clinical outcome is dissimilar for ESKD patients with different types of LVH, that is, eccentric or concentric LVH. To address this question, data from the CONvective TRAnsport STudy (CONTRAST) were analyzed.…”

Section: Introductionmentioning

confidence: 99%

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Eccentric Left Ventricular Hypertrophy and Sudden Death in Patients with End-Stage Kidney Disease

Zuijdewijn¹,

Hansildaar²,

Bots

et al. 2015

Am J Nephrol

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Background/Aims: Both all-cause and cardiovascular mortality risks are extremely high in patients with end-stage kidney disease (ESKD). Sudden death accounts for approximately one-quarter of all fatal events. Left ventricular hypertrophy (LVH) is a known risk factor for mortality and can be divided in 2 types: concentric and eccentric. This study evaluated possible differences in all-cause mortality, cardiovascular mortality and sudden death between prevalent ESKD patients with concentric and eccentric LVH. Methods: Participants of the CONvective TRAnsport STudy (CONTRAST) who underwent transthoracic echocardiography (TTE) at baseline were analyzed. In patients with LVH, a relative wall thickness of ≤0.42 was considered eccentric and >0.42 was considered concentric hypertrophy. Cox proportional hazards models, adjusted for potential confounders, were used to calculate hazard ratios (HRs) of patients with eccentric LVH versus patients with concentric LVH for all-cause mortality, cardiovascular mortality and sudden death. Results: TTE was performed in 328 CONTRAST participants. LVH was present in 233 participants (71%), of which 87 (37%) had concentric LVH and 146 (63%) eccentric LVH. The HR for all-cause mortality of eccentric versus concentric LVH was 1.14 (p = 0.52), 1.79 (p = 0.12) for cardiovascular mortality and 4.23 (p = 0.02) for sudden death in crude analyses. Propensity score-corrected HR for sudden death in patients with eccentric LVH versus those with concentric LVH was 5.22 (p = 0.03). Conclusions: (1) The hazard for all-cause mortality, cardiovascular mortality and sudden death is markedly increased in patients with LVH. (2) The sudden death risk is significantly higher in ESKD patients with eccentric LVH compared to subjects with concentric LVH.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Eccentric Left Ventricular Hypertrophy and Sudden Death in Patients with End-Stage Kidney Disease

Zuijdewijn¹,

Hansildaar²,

Bots

et al. 2015

Am J Nephrol

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“…general population, coronary artery disease and CHF are not the major risk factors in dialysis patients (16). In prevalent HD patients, LVH was associated with sudden death (17,18); in another study of PD patients, systolic dysfunction was the most significant predictor followed by a high systolic BP (24). These results might explain the association of low T3 syndrome with sudden death considering that low T3 was associated with left ventricular dysfunction and LVH in a previous study (7).…”

Section: Discussionmentioning

confidence: 87%

“…Indeed, when taken as a single cause, sudden death accounts for onequarter of all dialysis patients' deaths (16). Left ventricular hypertrophy (LVH), left ventricular systolic dysfunction, and aortic stiffness are known to be risk factors for sudden death (16)(17)(18), and are also significantly associated with low T3 syndrome (7,9,10) in dialysis patients. Considerable evidence has raised the possibility that low T3 syndrome may be a predisposing factor for sudden death, but the relationship between the two has not yet been determined in PD patients.…”

Section: Introductionmentioning

confidence: 99%

Low Triiodothyronine Syndrome and Long-Term Cardiovascular Outcome in Incident Peritoneal Dialysis Patients

Chang

Nam

Shin

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives A direct association between low triiodothyronine (T3) syndrome and cardiovascular (CV) mortality has been reported in hemodialysis patients. However, the implications of this syndrome in peritoneal dialysis (PD) patients have not been properly investigated. This study examined the association between low T3 syndrome and CV mortality including sudden death in a large cohort of incident PD patients.Design, setting, participants, & measurements This prospective observational study included 447 euthyroid patients who started PD between January 2000 and December 2009. Measurement of thyroid hormones was performed at baseline. All-cause and cause-specific deaths were registered during the median 46 months of follow-up. The survival rate was compared among three groups based on tertile of T3 levels.Results In Kaplan-Meyer analysis, patients with the lowest tertile were significantly associated with higher risk of all-cause and CV mortality including sudden death (P,0.001 for trend). In Cox analyses, T3 level was a significant predictor of all-cause mortality (per 10-unit increase, adjusted hazard ratio [HR], 0.86; 95% confidence interval [95% CI], 0.78 to 0.94; P=0.002), CV death (per 10-unit increase, adjusted HR, 0.84; 95% CI, 0.75 to 0.98; P=0.01), and sudden death (per 10-unit increase, adjusted HR, 0.69; 95% CI, 0.56 to 0.86; P=0.001) after adjusting for well known risk factors including inflammation and malnutrition. The higher T3 level was also independently associated with lower risk for sudden death (per 10-unit increase, adjusted HR, 0.71; 95% CI, 0.56 to 0.90; P=0.01) even when accounting for competing risks of death from other causes.Conclusions T3 level at the initiation of PD was a strong independent predictor of long-term CV mortality, particularly sudden death, even after adjusting well known risk factors. Low T3 syndrome might represent a factor directly implicated in cardiac complications in PD patients.

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“…5,22 The close association between inflammation, hypoalbuminemia and OH was also confirmed by other studies, which found inflammation and hypoalbuminemia being the strongest determinants of OH. 23,24 On one hand, malnutrition and low albumin level contribute to systemic inflammation through tissue OH, while on the other hand, as a result of a kind of vicious circle, chronic inflammation leads to hypoalbuminemia, and ultimately to OH. 4,25 Furthermore, diabetes and diabetic nephropathy may be an additional risk factor for malnutrition in PD patients.…”

Section: Parametersmentioning

confidence: 99%

The importance of hypoalbuminemia in peritoneal dialysis patients: Impact of gender

Sikorska¹,

Olewicz‐Gawlik²,

Baum³

et al. 2018

Adv Clin Exp Med

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Background. High mortality in peritoneal dialysis (PD) patients is associated with the presence of nontraditional cardiovascular risk factors, such as malnutrition. However, hypoalbuminemia in patients undergoing PD may have gender-dependent consequences. Objectives. The aim of the study was to evaluate the relationship between hypoalbuminemia, overhydration (OH), inflammation, and cardiovascular risk, depending on gender. Material and methods. The group studied consisted of 54 PD patients: 26 male (mean age: 59 ±19 years) and 28 female (mean age: 52 ±15 years). Serum albumin levels were measured routinely by the hospital central laboratory. The degree of OH was assessed by bioelectrical impedance analysis (BIA). Serum concentrations of C-reactive protein (CRP) and interleukin (IL)-6 were measured as inflammatory markers. Levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and troponin T (TnT) were used to assess cardiovascular risk. Results. Median serum albumin concentration was 3.9 g/dL (3.6-4.2 g/dL). Both genders were comparable regarding most parameters except body weight (79 ±16 kg vs 67 ±16 kg; p = 0.009), but no differences were observed in body mass index (BMI) (26.3 ±5.0 kg/m 2 vs 26.2 ±5.9 kg/m 2 ; non significant (NS)). There was also no difference in the prevalence of hypoalbuminemia between female and male PD patients (23% vs 21%; NS). In females, low serum albumin concentrations were associated with OH, inflammation and cardiovascular risk, while in males serum albumin levels correlated with the parameters of dialysis and cardiovascular risk. Conclusions. The impact of hypoalbuminemia may be gender-dependent. It seems that hypoalbuminemia is more important for female patients. It is also possible that different mechanisms regulate serum albumin concentration in female and male PD patients.

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Left Ventricular Mass in Dialysis Patients, Determinants and Relation with Outcome. Results from the COnvective TRansport STudy (CONTRAST)

Cited by 30 publications

References 39 publications

Eccentric Left Ventricular Hypertrophy and Sudden Death in Patients with End-Stage Kidney Disease

Eccentric Left Ventricular Hypertrophy and Sudden Death in Patients with End-Stage Kidney Disease

Low Triiodothyronine Syndrome and Long-Term Cardiovascular Outcome in Incident Peritoneal Dialysis Patients

The importance of hypoalbuminemia in peritoneal dialysis patients: Impact of gender

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