Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs

Özkahya, Mehmet; Ok, Ercan; Cirit, Murat; Aydın, Sibel Zehra; Akçiçek, Fehmi; Başçı, Alı; Mees, E. J. Dorhout

doi:10.1093/ndt/13.6.1489

Cited by 177 publications

(150 citation statements)

References 1 publication

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“…Therefore, it is not easy to separate the effects of preload and afterload factors in the pathogenesis of LVH or even to establish a hierarchy of importance because they are intimately related to each other in ESRD patients. Nevertheless, evidence has accumulated to suggest that volume overload, related to inadequate salt restriction and ultrafiltration, plays a dominant role (33,34 …”

Section: What Are the Likely Pathophysiologic And Pathobiologic Mechamentioning

confidence: 99%

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Glassock

Pecoits‐Filho

Barberato

2009

Clinical Journal of the American Society of Nephrology

322

279

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Chronic kidney disease (CKD) and ESRD, treated with conventional hemo-or peritoneal dialysis are both associated with a high prevalence of an increase in left ventricular mass (left ventricular hypertrophy [LVH]), intermyocardial cell fibrosis, and capillary loss. Cardiac magnetic resonance imaging is the best way to detect and quantify these abnormalities, but M-Mode and 2-D echocardiography can also be used if one recognizes their pitfalls. The mechanisms underlying these abnormalities in CKD and ESRD are diverse but involve afterload (arterial pressure and compliance), preload (intravascular volume and anemia), and a wide variety of afterload/preload independent factors. The hemodynamic, metabolic, cellular, and molecular mediators of myocardial hypertrophy, fibrosis, apoptosis, and capillary degeneration are increasingly well understood. These abnormalities predispose to sudden cardiac death, most likely by promotion of electrical instability and re-entry arrhythmias and congestive heart failure. Current treatment modalities for CKD and ESRD, including thrice weekly conventional hemodialysis and peritoneal dialysis and metabolic and anemia management regimens, do not adequately prevent or correct these abnormalities. A new paradigm of therapy for CKD and ESRD that places prevention and reversal of LVH and cardiac fibrosis as a high priority is needed. This will require novel approaches to management and controlled interventional trials to provide evidence to fuel the transition from old to new treatment strategies. In the meantime, key management principles designed to ameliorate LVH and its complications should become a routine part of the care of the patients with CKD and ESRD.

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Section: What Are the Likely Pathophysiologic And Pathobiologic Mechamentioning

confidence: 99%

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Glassock

Pecoits‐Filho

Barberato

2009

Clinical Journal of the American Society of Nephrology

322

279

View full text Add to dashboard Cite

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“…As these treatment modalities greatly facilitate volume control, it is tempting to ascribe these results to a decrease in blood volume and pre-load. The importance of reversing increased pre-load was illustrated by the report of Ozkahya et al, 7 who showed that reversal of hypervolaemia through reduced dietary salt intake and ultrafiltration caused a reduction in LVH in dialysis patients, even without the use of anti-hypertensive agents. All of the above studies support the importance of a reduction in the left ventricular volume for the regression of LVH.…”

Section: Strict Fluid Volume Control and Lvh In Haemodialysis Patientmentioning

confidence: 99%

“…5 While it has been reported that LVH is mostly persistent and progressive despite anti-hypertensive drug treatment, 6 some studies have shown a remarkable reversal of LVH in ESRD patients treated by strict fluid volume control without drugs. 7,8 The exact pathophysiology of LVH in ESRD patients is unknown, but hypertension, volume overload, anaemia, uraemia and arteriovenous shunts are implicated. 9,10 In patients with systemic hypertension, the development of LVH is thought to be caused by the increased pressure load imposed on the left ventricle.…”

Section: Introductionmentioning

confidence: 99%

Strict Fluid Volume Control and Left Ventricular Hypertrophy in Hypertensive Patients on Chronic Haemodialysis: A Cross-Sectional Study

Karaca

Aygen

et al. 2004

J Int Med Res

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Left ventricular hypertrophy (LVH) is very common in haemodialysis patients.We measured left ventricular mass in three groups of haemodialysis patients: group A (n = 40) were normotensive and receiving a strict salt-restricted diet; group B (n = 23) were normotensive and receiving antihypertensive drugs; and group C (n = 43) were hypertensive despite anti-hypertensive drug treatment. The interdialytic weight gain in group B and group C was significantly higher than in group A; the mean left atrial index and left ventricular end-systolic and end-diastolic diameter indices were all higher in group B than in group A. The interventricular septum and posterior wall were significantly thicker in group B and group C than group A, resulting in a higher left ventricular mass index. Left ventricular systolic and diastolic function parameters were slightly better in group A than in the other groups. These results show that strict fluid volume control decreases blood pressure, reduces dilated cardiac compartments and corrects LVH more effectively than lowering blood pressure without correcting the volume overload.

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“…In the past, some authors have accepted heart disease as a usual process for these patients, suggesting that deterioration is inevitably linked to that procedure (14). On the contrary, Charra and Özkahya (15,16) have proven that a precise volume control of HD patients decreases arterial blood pressure, causes regression of cardiac hypertrophy and prolongs survival. This suggests that volume control is not enough in most patents, despite the fact that treating physicians may consider that ''Dry Weight'' (DW) of their patients has been reached.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients

Hür¹,

Budak²,

Mağden³

et al. 2017

Turk Neph Dial Transpl

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OBJECTIVE: Hypervolemia and malnutrition are often undiagnosed risk factors for hemodialysis (HD). Our aim was to investigate the long-term effects of hypervolemia and malnutrition evaluated by bioimpedance spectroscopy (BIS) on survival. (Clinical Trials. Gov Identifier: NCT01468363). MATERIAL and METHODS:A total of 431 Prevalent HD patients were followed for 32.2±14.4 months. The patients underwent BIS measurement, a medical history was obtained, and routine tests were analyzed at the baseline and at the end of the study. Hospitalizations and complications of HD were recorded. RESULTS:The mean age was 59.4±14.6 (10-92) years with a total of 431 (53.6% males) patients of which 125 died. The percentage of diabetics was 47%, erythropoietin use 67%, and diuretic use 40%. Predialysis systolic blood pressure (BP) was 133.4±25.8 and diastolic BP 79.2±12.4 mm Hg.The rate of diabetes, and the number of hospitalizations and blood transfusions were higher in the patients who died. Diastolic BP as a clinical hypervolemia finding, BIS hypervolemia indicator of over hydration (OH), and extracellular water (ECW) were all increased, and fat tissue index as a malnutrition finding was decreased in patients who died. There were significant rates of anemia and hypoalbuminemia in this group as well.The cumulative survival was lower in hypervolemic patients as assessed by relative hydration status OH/ECW. CONCLUSION:Hypervolemia and malnutrition are the long-term mortality indicators in hemodialysis. Early diagnosis and treatment is important. Clinical findings may not be sufficient and laboratory and BIS methods can be used for diagnosis. Ölen hastaların diyabet oranı, hastaneye yatışları ve kan transfüzyon sayıları daha fazla idi. Ölen hastalarda: klinik hipervolemi bulgularından diyastolik kan basıncı, BİS hipervolemi göstergesi olan aşırıhidrasyon (OH), Hücredışı su (ECW), artmış, malnütrisyon bulgusu olarak yağ kitle endeksi azalmıştı. Bu grupta anlamlı anemi ve hipoalbuminemi mevcuttu.

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Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs

Abstract: The results of this uncontrolled retrospective study suggest that good long-term BP control and a decrease of LVM can be achieved by continuous efforts to control hypervolaemia. The decrease in volume may be even more important than pressure reduction to achieve this goal.

Cited by 177 publications

References 1 publication

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Left Ventricular Mass in Chronic Kidney Disease and ESRD

Strict Fluid Volume Control and Left Ventricular Hypertrophy in Hypertensive Patients on Chronic Haemodialysis: A Cross-Sectional Study

The Relationship Between Bioimpedance-Measured Volume and Nutritional Parameters and Mortality in Hemodialysis Patients

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