Prevalence and Risk Factors of Myocardial Remodeling in Hemodialysis Patients

Abstract

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.

Association between Cystatin C and MRI Measures of Left Ventricular Structure and Function: Multi-Ethnic Study of Atherosclerosis

“…Renal insufficiency is a known risk factor for heart failure [23], diastolic dysfunction, and LV remodeling [24]. The risk of cardiovascular remodeling attributable to mild-to-moderate renal insufficiency may not be fully captured by current estimates of renal function such as creatinine, GFR, and creatinine clearance.…”

Left ventricular geometric patterns in end‐stage kidney disease: Determinants and course over time

“…Abnormal LV geometry is widespread in renal patients . While most studies, but not all, reported that cLVH predominates in non–dialysis‐dependent (NDD)‐CKD, eLVH appears most prevalent in CKD5D . Primarily subjects with cLVH, who carry a high risk of stroke, may suffer from the combined deleterious effects of the biochemical and circulatory alterations that occur during the transition from advanced CKD to early CKD5D .…”

“…3 While most studies, 3,6-8 but not all, 9 reported that cLVH predominates in non-dialysis-dependent (NDD)-CKD, eLVH appears most prevalent in CKD5D. 10,11 Primarily subjects with cLVH, who carry a high risk of stroke, 12 may suffer from the combined deleterious effects of the biochemical and circulatory alterations that occur during the transition from advanced CKD to early CKD5D. 13 Moreover, LV features may change over time as observed both in participants of the Framingham Heart Study (FHS) 14 and CKD patients stage 3 to 4 who took part of the Cardiovascular Risk reduction by Early Anemia Treatment with Epoietin beta (CREATE) trial.…”

Predictors of quality of life of hemodialysis patients in India

“…It has been reported that increased IDWG[18] is a risk factor for low QoL scores. Increased IDWG predisposes the patient to rapid and large-volume ultrafiltration with its associated intradialytic hypotension, cramps, dialysis-related headache,[1920] interdialytic hypertension[21] and left ventricular hypertrophy.…”