Pathophysiology of Left Ventricular Hypertrophy in Dialysis Patients

London, Gérard M.; Guérin, Alain P.; Marchais, Sylvain J.

doi:10.1159/000170174

Cited by 32 publications

(25 citation statements)

References 26 publications

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“…3 Uremic patients are at especially high cardiovascular risk, and LV hypertrophy, which is fundamentally determined by volume and pressure load 15 and accompanies combined LV dysfunction, is the main component of this risk. 16,17 Our study confirmed that LV hypertrophy is also a predictor of CHF events in patients on HD.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Congestive Heart Failure in Patients on Maintenance Hemodialysis

Ito¹,

Murai²,

Sugiura³

et al. 2007

Circ J

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Background Cardiovascular disease is a major cause of death in patients on maintenance hemodialysis (HD). Predictors of congestive heart failure (CHF) events in patients on HD were investigated, focusing on left ventricular (LV) function. Methods and ResultsOne hundred consecutive patients on HD were followed for at least 5 years after index examination performed 1 day after the last HD session. Tests included M-mode and Doppler echocardiography and plasma brain natriuretic peptide (BNP) and hemoglobin (Hb) concentration measurements. Patients with atrial fibrillation or poor echocardiographic images were excluded. Confounding factors included diabetes mellitus (DM), hypertension, age, HD duration, LV fractional shortening, E/A of transmitral flow velocity pattern, Tei index, LV mass index (LVMI), BNP level, Hb, and use of antihypertensive or antiarrhythmic drugs. Six CHF events occurred during 1,703±565 days. DM and Hb <10 g/dl were identified as independent predictors of CHF events in a stepwise Cox regression model after DM, LVMI, BNP, and Hb <10 g/dl were selected in the univariate analysis. The hazard ratio (confidence interval) was 10.96 (1.49-80.44) for DM, and 23.00 (2.41-219.76) for Hb <10 g/dl. The estimated hazard across time was constant (T_COV*DM; p=0.726, T_COV*Hb <10 g/dl; p=0.681) by time-dependent covariates analysis. Conclusion In patients on maintenance HD, DM and anemia (Hb <10 g/dl), but not echo-derived cardiac function, predicted CHF events. (Circ J 2007; 71: 1424 -1429

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Section: Discussionmentioning

confidence: 99%

Predictors of Congestive Heart Failure in Patients on Maintenance Hemodialysis

Ito¹,

Murai²,

Sugiura³

et al. 2007

Circ J

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“…We only found a relation of LVH with PTH levels in the patients on short dialysis. Other factors contributing to LVH are age, hypervolemia, dialysis fistulae, and perhaps uremic toxins [52].…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Control and Hemodynamic Changes in Patients on Long Time Dialysis Treatment

et al. 1998

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In dialysis patients blood pressure can be well controlled with long dialysis (3 times a week for 8 h) in contrast to a more common short dialysis regime (3 times a week for 4 h). We studied whether the good blood pressure control in patients on long dialysis as compared to patients on short dialysis was associated with a decrease in extracellular fluid volume. Two-day interdialytic ambulatory blood pressure monitoring was performed in 26 non-diabetic patients on long dialysis, in 22 patients on short dialysis, matched for the years they were on dialysis treatment, and during 24 h in 19 healthy volunteers. After full equilibration, 24 h after dialysis, echography of the inferior caval vein was performed to determine fluid state. Cardiac dimensions and stroke index were measured by echocardiography. A blood sample was drawn for the determination of electrolytes and vasoactive hormones. 73% of the patients on short dialysis were using antihypertensive medication in contrast to none of the patients on long dialysis. However, blood pressure was significantly lower in patients on long dialysis (115 ± 21/67 ± 11 mm Hg) when compared to patients on short dialysis (143 ± 26/81 ± 16 mm Hg). Indexed caval vein diameter, left ventricular diameter index, and atrial natriuretic peptide were not significantly different in patients on long dialysis compared to patients on short dialysis. Also the cardiac index was comparable in patients on long and short dialysis. However, the total peripheral resistance index was significantly lower in patients on long dialysis compared to the patients on short dialysis and normal controls. The left ventricular mass index was increased in both patients on long and short dialysis compared to controls. We conclude that patients on long dialysis have adequate blood pressure control that seems mainly to be caused by a low total peripheral resistance. These data also suggest that factors other than a lower fluid state contribute to the good blood pressure control in patients on long dialysis.

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“…[1][2][3][4] Thought to result from an increased cardiac load due to volume overload and altered peripheral resistance, [5][6][7][8] LVH is also an independent risk factor for mortality in dialysis patients. [1,9] Comparing treatment modalities, Enia et al [10] investigated European dialysis patients and found a higher degree of volume overload and more LVH in continuous ambulatory peritoneal dialysis (PD) as compared to hemodialysis (HD) patients. This was especially true of long-term PD patients, presumably due to a loss of residual renal function and thus an exacerbated volume overload.…”

Section: Introductionmentioning

confidence: 99%

The Prevalence of Left Ventricular Hypertrophy in Chinese Hemodialysis Patients Is Higher Than That in Peritoneal Dialysis Patients

et al. 2008

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Background. Left ventricular hypertrophy (LVH) is common in dialysis patients, and an independent predictor of mortality. While recent studies have shown no differences in mortality between the two most common dialysis modalities, hemodialysis (HD) and peritoneal dialysis (PD), their impact on LVH is controversial. We thus performed cardiac ultrasound studies in prevalent dialysis patients receiving either HD or PD and compared LVH. Methods. We included 48 HD and 62 PD patients receiving treatment for at least three months in our dialysis center. All patients underwent echocardiographic examination and blood pressure measurements immediately following therapy. Volume status was assessed by bioelectrical impedance analysis. Results. There was no baseline difference in demographics or comorbidities between HD and PD patients. As expected, extracellular water (ECW) in post-HD patients was significantly lower than that in pre-HD and PD patients, while cardiac output (CO) and systolic blood pressure (SBP) were higher in pre-HD than that in post-HD or PD patients. There was no significant difference in CO or SBP between post-HD and PD patients. Left ventricular mass index (LVMI) was markedly higher in HD patients as compared to PD patients. Thus, the prevalence of LVH according to the Framingham criteria was 68.8% in HD patients and 45.2% in PD patients. Subgroup analysis showed similar results in the patients who had been on single-modality dialysis for at least two years and in the anuric patients. Finally, in a linear regression model (r 2 = 0.364, p < 0.001), SBP, treatment modality (to be in HD), and ECW were all independent predictors of LVMI. Conclusions. In a crosssectional analysis of prevalent Chinese patients, we found a higher LVMI and a higher prevalence of LVH in HD than in PD patients. As LVMI was associated with high blood pressure and volume overload, we suggest that in these patients, PD may preserve more physiological hemodynamics even during long-term therapy. Keywords

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Pathophysiology of Left Ventricular Hypertrophy in Dialysis Patients

Cited by 32 publications

References 26 publications

Predictors of Congestive Heart Failure in Patients on Maintenance Hemodialysis

Predictors of Congestive Heart Failure in Patients on Maintenance Hemodialysis

Blood Pressure Control and Hemodynamic Changes in Patients on Long Time Dialysis Treatment

The Prevalence of Left Ventricular Hypertrophy in Chinese Hemodialysis Patients Is Higher Than That in Peritoneal Dialysis Patients

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