Prognostic significance of left ventricular hypertrophy observed at dialysis initiation depends on the pre-dialysis use of erythropoiesis-stimulating agents

Hayashi, Terumasa; Kimura, Tomonori; Yasuda, Keiko; Obi, Yoshitsugu; Sasaki, Koichi; Iio, Kenichiro; Miyasato, Kenro; Kamimura, Taro; Kitamura, Harumi; Tsubakihara, Yoshiharu; Rakugi, Hiromi; Isaka, Yoshitaka

doi:10.1007/s10157-012-0705-4

Cited by 10 publications

(6 citation statements)

References 45 publications

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“…Fourth, mortality prediction with no use of an ESA before initiation of HD is consistent with previous reports [ 27 , 28 ]. However, the beneficial effect of an ESA for CKD before the initiation of HD is controversial.…”

Section: Discussionsupporting

confidence: 90%

Risk Score to Predict 1-Year Mortality after Haemodialysis Initiation in Patients with Stage 5 Chronic Kidney Disease under Predialysis Nephrology Care

et al. 2015

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BackgroundFew risk scores are available for predicting mortality in chronic kidney disease (CKD) patients undergoing predialysis nephrology care. Here, we developed a risk score using predialysis nephrology practice data to predict 1-year mortality following the initiation of haemodialysis (HD) for CKD patients.MethodsThis was a multicenter cohort study involving CKD patients who started HD between April 2006 and March 2011 at 21 institutions with nephrology care services. Patients who had not received predialysis nephrology care at an estimated glomerular filtration rate (eGFR) of approximately 10 mL/min per 1.73 m2 were excluded. Twenty-nine candidate predictors were selected, and the final model for 1-year mortality was developed via multivariate logistic regression and was internally validated by a bootstrapping technique.ResultsA total of 688 patients were enrolled, and 62 (9.0%) patients died within one year of HD initiation. The following variables were retained in the final model: eGFR, serum albumin, calcium, Charlson Comorbidity Index excluding diabetes and renal disease (modified CCI), performance status (PS), and usage of erythropoiesis-stimulating agent (ESA). Their β-coefficients were transformed into integer scores: three points were assigned to modified CCI≥3 and PS 3–4; two to calcium>8.5 mg/dL, modified CCI 1–2, and no use of ESA; and one to albumin<3.5 g/dL, eGFR>7 mL/min per 1.73 m2, and PS 1–2. Predicted 1-year mortality risk was 2.5% (score 0–4), 5.5% (score 5–6), 15.2% (score 7–8), and 28.9% (score 9–12). The area under the receiver operating characteristic curve was 0.83 (95% confidence interval, 0.79–0.89).ConclusionsWe developed a simple 6-item risk score predicting 1-year mortality after the initiation of HD that might help nephrologists make a shared decision with patients and families regarding the initiation of HD.

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Section: Discussionsupporting

confidence: 90%

Risk Score to Predict 1-Year Mortality after Haemodialysis Initiation in Patients with Stage 5 Chronic Kidney Disease under Predialysis Nephrology Care

et al. 2015

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“…Similarly, in a smaller study of incident Japanese dialysis patients 68% had LVH 51 . More recent analyses of the Chronic Renal Insufficiency Cohort and a Japanese inception cohort showed that 79% and 85% of individuals starting dialysis had LVH at the time of initiation 52, 53 . LVH frequency is also high in prevalent dialysis patients but actually appears to be slightly less common.…”

Section: Prevalence and Progressionmentioning

confidence: 99%

“…However, a recently published study of 404 incident Japanese hemodialysis actually demonstrated that lower LVMI at baseline was associated with worse all-cause and CV survival in both crude and adjusted analyses. Interestingly, this “reverse epidemiology” was apparent only in patients without pre-dialysis erythropoietin use 53 .…”

Section: Association Of Baseline Lvh With Outcomesmentioning

confidence: 99%

Is left ventricular hypertrophy a modifiable risk factor in end-stage renal disease

Charytan

2014

Current Opinion in Nephrology and Hypertension

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Purpose of Review Left ventricular hypertrophy (LVH) is common in ESRD and has been advocated as a therapeutic target. We review considerations for targeting LVH as a modifiable risk factor in ESRD. Recent Findings Pathologic myocardial changes underlying LVH provide an ideal substrate for the spread of arrhythmia and may be key contributors to the occurrence of sudden death in ESRD. LVH is present in 68-89% of incident hemodialysis patients and is frequently progressive, although regression is observed in a minority of patients. Higher degrees of baseline LVH as well as greater increases in left ventricular mass index over time are associated with decreased survival, but whether these association are causal remains uncertain. Several interventions including angiotensin blockade and frequent dialysis can reduce left ventricular mass index but whether the associated decrease in left ventricular mass index is associated with improves survival has not been definitively demonstrated. Summary LVH is a highly prevalent and reversible risk factor which holds promise as a novel therapeutic target in ESRD. Interventional trials are needed to provide additional evidence that LVH regression improves survival before prevention and reversal of LVH can be definitively adopted as a therapeutic paradigm in ESRD.

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“…When adjusted for age and diabetes, LVH regression remained significantly associated with a decreased risk (HR 0.42, 95% CI 0.21-0.84) while age (HR Death (7) Technique failure (5) Transplants (15) Other (15) Regressors (n = 87) Death (4) Technique failure (4) Cardiovascular hospitalization (8) Transplant (28) Progressors (n = 57) Death (10) Technique failure (7) Cardiovascular hospitalization (6) Transplant ( ( table 5 ). On the basis of mortality alone, LVH regression was also significantly associated with a decreased risk of death in the unadjusted analysis (HR 0.24, 95% CI 0.08-0.77) and this remained significant after adjustment for age and diabetes (HR 0.20, 95% CI 0.06-0.67; table 6 ).…”

Section: Effect Of Lvh Regression On Clinical Outcomesmentioning

confidence: 99%

“…There has been increasing evidence that left ventricular hypertrophy (LVH) is an independent risk factor for mortality and cardiovascular events with important prognostic value in the ESRD population [3][4][5] . In fact, LVH increases in prevalence with progressive renal function decline, present in up to 85% of incident dialysis patients [6][7][8] . LVH in ESRD is multifactorial in origin; hypertension, vascular calcification, volume overload, anemia, hyperparathyroidism, inflammation, high sympathetic activity and various other metabolic and humoral changes having all been implicated in the pathophysiology [2,4,5,[9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 99%

Intensive Home Hemodialysis Results in Regression of Left Ventricular Hypertrophy and Better Clinical Outcomes

Trinh

Chan²

2016

Am J Nephrol

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Background: Left ventricular hypertrophy (LVH) is an independent risk factor for mortality and cardiovascular events in patients with end-stage renal disease. Studies have shown that frequent hemodialysis leads to LVH regression, but the impact of left ventricular mass (LVM) regression on clinical outcomes remains unknown. Methods: This observational cohort study assessed the impact of LVH regression on the composite outcome of time to all-cause mortality, technique failure or cardiovascular hospitalization in patients on home hemodialysis. LVH regression was defined as either a reduction of more than 10% in LVM in patients with LVH at baseline or prevention of LVH in those without LVH at baseline. Risk factors associated with progression of LVM were also examined. Results: We studied 144 intensive hemodialysis patients between 1999 and 2012 with a mean follow-up of 4.7 years. Eighty-seven patients (60.4%) had LVH regression or prevention and 57 patients (39.6%) had LVH progression. In a multivariate analysis, smoking (OR 2.78, 95% CI 1.06-7.36) and presence of LVH at baseline (OR 2.21, 95% CI 1.06-4.59) were significant predictors for LVM progression. Sixteen patients (18.4%) in the regressor group and 19 patients (33.3%) in the progressor group developed the composite end point. When adjusted for age and diabetes, regression was significantly associated with a decreased risk (hazards ratio (HR) 0.42, 95% CI 0.21-0.84) for the composite end point. Regression was also significantly associated with a decreased risk of death in the adjusted analysis (HR 0.20, 95% CI 0.06-0.67). Conclusions: Regression of LVH with intensive hemodialysis is associated with favorable clinical outcomes.

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Prognostic significance of left ventricular hypertrophy observed at dialysis initiation depends on the pre-dialysis use of erythropoiesis-stimulating agents

Abstract: Our results suggest that reverse epidemiology may exist between LVH and mortality and that pre-dialysis ESA use may modify the prognostic significance of LVH observed at dialysis initiation for cardiovascular mortality in dialyzed patients.

Cited by 10 publications

References 45 publications

Risk Score to Predict 1-Year Mortality after Haemodialysis Initiation in Patients with Stage 5 Chronic Kidney Disease under Predialysis Nephrology Care

Risk Score to Predict 1-Year Mortality after Haemodialysis Initiation in Patients with Stage 5 Chronic Kidney Disease under Predialysis Nephrology Care

Is left ventricular hypertrophy a modifiable risk factor in end-stage renal disease

Intensive Home Hemodialysis Results in Regression of Left Ventricular Hypertrophy and Better Clinical Outcomes

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