Hypertension and hyperparathyroidism are associated with left ventricular hypertrophy in patients on hemodialysis

Al-Hilali, Nabieh; Hussain, N; Ataia, A I; Al-Azmi, M; Al-Helal, Bassam; Johny, K.V.

doi:10.4103/0971-4065.59337

Cited by 14 publications

(10 citation statements)

References 28 publications

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“…We suppose multifactorial impact on left ventricular geometry in which circulating blood volume plays the main role (11). In agreement with other authors we confi rmed the relation of LVMI, RT and blood pressure (SBP, DBP and MAP and partially PP) during 24 hours -diurnal confi rmation (12,13).…”

Section: Discussionsupporting

confidence: 92%

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Bobocka¹,

Dúbrava²,

Slezák³

et al. 2013

BLL

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Abstract:Aim: Left ventricular hypertrophy in chronic haemodialysis patients is multifactorial. Our aim was to evaluate retrospectively the relationship between 24-h blood pressure monitoring and geometry and function of left ventricle (LV). Patients a methods:We examined 50 patients (men/women 33/17) treated by chronic haemodialysis (>3 months) aged 57.5 years (53-63; median, interquartile range). We measured blood pressure during 24 hours in short interdialytic period using Spacelab monitor 90217. Echocardiography was provided in short interdialytic period. Results: Left ventricular mass index signifi cantly correlated with SBP (tau-b=0.21; p=0.030; 95%CI 0.01-0.42), p=0.018; p=0.009;. SBP, DBP, MAP and PP did add a signifi cant information to the prediction of relative wall thickness. We did not fi nd any relationship between BP and left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size. Conclusion:We found out an important 24-hour blood pressure impact on left ventricular relative wall thickness and left ventricular mass index. Left ventricular ejection fraction, left ventricular enddiastolic diameter and left atrial size were not related to 24-hour blood pressure. We did not fi nd a relationship between blood pressure and left ventricular enddiastolic diameter. From all diastolic parameters the strongest association was found between systolic blood pressure in all three phases and ratio of peak early to late diastolic fi lling velocity (Tab. 5, Ref. 19 Cardiovascular complications of haemodialysis treatment are the most common cause of increased morbidity and mortality among these patients (1). Already stage 3 chronic kidney disease patients with glomerular fi ltration rate <60 ml/min/1.73m 2 belongs to the high cardiovascular risk group (2). Echocardiography verifi ed left ventricular concentric or excentric hypertrophy is present at the beginning of haemodialysis treatment in 50-75 %, while during the next course the amount is further increasing (3). Uremic cardiomyopathy is a term used in connection with disturbed left ventricular morphology and funtion in renal failure. It is a myocardial dysfunction, which occured due to long lasting impact of hemodynamic and non-hemodynamic, with uraemia and dialysis associated risk factors. Arterial hypertension, volume overload, anaemia, uremic toxins, hyperparathyroidism and increased sympathetic activity belong to the most dominant risk factors (4). A strong relationship between left ventricular (LV) mass and blood pressure was shown also in a non-uraemic population. To confi rm this relationship in haemodialysis patients is more diffi cult due to many factors affecting LV mass. Blood pressure values obtained by ambulatory or home blood pressure monitoring provide more prognostic information on cardiovascular risk compared to blood pressure values measured during haemodialysis (5, 6).Aim of the retrospective study was to evaluate the impact of blood pressure measured by 24-hour ambulatory blood pressure monitoring (24-h A...

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Section: Discussionsupporting

confidence: 92%

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Bobocka¹,

Dúbrava²,

Slezák³

et al. 2013

BLL

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“…Furthermore, Al-Hilali et al . [51] found positive correlation between iPTH and LVMI in their study on their patients on hemodialysis. This may be due to the potential role of iPTH on inter myocyte fibrosis, namely nonreparative interstitial fibrosis with collagen fiber deposition, commonly found in patients with ESRD as reported by Amann et al .…”

Section: Discussionmentioning

confidence: 99%

Early predictors of cardiac dysfunction in Egyptian children with chronic kidney disease

2019

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Background:Cardiovascular morbidity (CVM) is the main etiology of mortality in children and adolescents with chronic kidney disease (CKD). CKD associated cardiovascular mortality is more common in children with diastolic cardiac dysfunction which was considered as an early indicator for death, while increased left ventricular mass (LVM) is a strong independent risk factor for these patients. Vitamin D deficiency was previously studied as one of the risk factors for CVM.Aim:The aim of the work was to investigate the relationship between biomarkers of mineral bone disorder including serum 25(OH) Vitamin D3 (25-OH D3), phosphorus and calcium × phosphorus (Ca×Po4) product with diastolic cardiac function and LVM in children and adolescents with CKD.Subjects and Methods:This was a cross-sectional observational study. Participants were classified into two groups: Group I including 86 pediatric patients with CKD (stages 4 or 5) and Group II including 40 healthy controls. Group I was subdivided into IA included children with diastolic dysfunction and IB included cases without diastolic dysfunction. 25-OH D3 level was measured by enhanced chemiluminescence method and intact parathyroid hormone (iPTH) by electrochemiluminescence method. Parameters for diastolic function and LVM were assessed by Doppler echocardiography, tissue Doppler imaging, and M-mode echocardiography.Results:25-OH D3 level was significantly lower in Group I when compared to Group II. Diastolic dysfunction was present in 48.8% of the studied patients and was significantly associated with increased serum phosphorus and calcium-phosphorus product but not with decreased level of 25-OH D3. There was a significant positive correlation between LVM and iPTH.Conclusions:Hyperphosphatemia and high Ca×Po4 product were considered of prognostic value as they predict early diastolic dysfunction and increased LVM in children with CKD.

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“…High iPTH levels have also been shown to be associated with left ventricular hypertrophy (LVH) in haemodialysis patients and the relationship between iPTH and LVH is thought to be independent of blood pressure (31,32). A reduction in LVMI was seen in both arms of our study with no signi cant difference between treatment arms.…”

Section: Discussionmentioning

confidence: 43%

A randomised controlled trial to examine the effects of cinacalcet on bone, cardiovascular parameters and mortality in haemodialysis patients with secondary hyperparathyroidism

Eddington

Chinnadurai

Alderson

et al. 2020

Preprint

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Background Secondary hyperparathyroidism may lead to increased cardiovascular risk. The use of cinacalcet may improve bone and cardiovascular health with improved parathormone (PTH) and phosphate control. Methods This is an open-label prospective randomised controlled trial to compare progression of cardiovascular and chronic kidney disease mineral and bone disorder (CKD-MBD) parameters. Patients were randomised to receive cinacalcet alongside standard therapy or standard therapy alone. 36 haemodialysis patients who had >90 days on dialysis, iPTH >300pg/mL, calcium >2.1mmol/L and age 18-75 years were included. Following randomization, all 36 patients underwent an intensive 12-week period of bone disease management aiming for iPTH 150-300pg/mL. The primary outcome was change in vascular calcification using CT agatston score. Secondary outcomes included pulse wave velocity (PWV), left ventricular mass index (LVMI), carotid intima-media thickness (CIMT), augmentation index (Aix) and bone measurements. The above measurements were obtained at baseline and 12 months. The difference in mortality between the groups was compared during long-term follow-up. Results There was no evidence of a group difference in the progression of calcification (median change (IQR) cinacalcet: 488 (0 to1539); standard therapy: 563 (50 to 1214)). In a post hoc analysis combining groups there was a mean (SD) phosphate reduction of 0.3mmol/L (0.7) and median (IQR) iPTH reduction of 380pg/mL (-754, 120). Regression of LVMI and CIMT was seen (P=0.03 and P=0.001) and was significantly associated with change of phosphate on multi-factorial analyses. Over a median follow-up of 32 months, there was no significant difference in the mortality between the two groups.Conclusions No significant benefit in bone and cardiovascular markers was seen with the addition of cinacalcet to standard therapy over one year. Tight control of hyperphosphataemia and secondary hyperparathyroidism may lead to a reduction in LVMI and CIMT but this needs further investigation. Although the sample size was small, meticulous trial supervision resulted in very few protocol deviations with therapy.

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Hypertension and hyperparathyroidism are associated with left ventricular hypertrophy in patients on hemodialysis

Cited by 14 publications

References 28 publications

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Blood pressure impact on left ventricular geometry in chronic haemodialysis patients

Early predictors of cardiac dysfunction in Egyptian children with chronic kidney disease

A randomised controlled trial to examine the effects of cinacalcet on bone, cardiovascular parameters and mortality in haemodialysis patients with secondary hyperparathyroidism

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