Left ventricular hypertrophy in a contemporary cohort of autosomal dominant polycystic kidney disease patients

Abstract

BackgroundPatients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) often develop hypertension in childhood or early adulthood. Although this could result in left ventricular hypertrophy (LVH), a major risk factor for cardiovascular morbidity and mortality, prior studies of LVH in ADPKD have yielded conflicting results. We estimated the prevalence of LVH using consensus echocardiography criteria and examined the independent association of ADPKD severity with LV mass in a contemporary cohort of ADPKD patients.MethodsAdults with ADPKD and eGFR> 15 ml/min/1.73m2 were enrolled in a single-center study. Left Ventricular Mass (LVM) was quantified using 2D echocardiography, and LVH was defined using gender-specific cut-points of LVM and LVM indexed to body surface area (LVMI) from consensus guidelines. Total Kidney Volume (TKV) was quantified using Magnetic Resonance Imaging, and GFR was estimated from serum creatinine using the CKD-Epi equation. Multiple linear regression was used to estimate the association of TKV and eGFR with LVM and LVMI, adjusting for potential confounders.ResultsAmong 126 participants (78% with hypertension), median age was 46 years, median eGFR 63 ml/min/1.73 m2, and median [IQR] systolic blood pressure was 125 [116–133] mmHg. Prevalence of LVH was 21.4% as defined by LVMI and was not significantly different (p = 0.8) between those with and without HTN, and was similar (21.4%) after excluding those (N = 21) with known cardiac disease. Greater TKV and lower eGFR were directly correlated with greater LVMI (p = .016 and p < .001, respectively). In multiple linear regression models accounting for potential confounders including blood pressure, greater TKV was positively associated with LVM ( =0.19, p = 0.04).ConclusionsIn a contemporary cohort of ADPKD patients with well-controlled blood pressure, the prevalence of LVH is high, and ADPKD severity as reflected by TKV is independently associated with greater LV mass. These results may suggest a relationship between ADPKD pathophysiology and increased LV mass.

Cardiovascular Outcomes in Kidney Transplant Recipients With ADPKD

“…44 These medications play a major role in the regression of LVH. 45 The early and aggressive management of hypertension with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is reported to be the main reason why the prevalence of LVH may be lower in ADPKD compared with other patients with CKD. The HALT PKD trial reported only a 4% prevalence of LVH in its large cohort of hypertensive patients with ADPKD.…”

The wind of change in the management of autosomal dominant polycystic kidney disease in childhood

“…This may be due to intrarenal activation of the renin-angiotensin system by local cystic destruction and a high incidence of hypertension [ 13 , 20 ]. Placebo-controlled trials are not available for patients with ADPKD, but the decrease over time of the very high incidence of left ventricular hypertrophy in this group may be attributable to the more intensive treatment approaches to hypertension [ 86 ]. In the HALT-PKD A study, more intensive lowering of blood pressure (but not single vs. dual RAS blockade) resulted in a greater decline of left ventricular mass index in adults with early ADPKD [ 87 ].…”

Echocardiographic Abnormalities in Autosomal Dominant Polycystic Kidney Disease (ADPKD) Patients

“…According to some studies, increased LVMI in normotensive ADPKD patients correlated with 24h ambulatory systolic BP or with an exaggerated systolic BP response to exercise [ 8 , 59 ]. However, the prevalence of increased LVMI is highly variable in the literature ranging from up to 48% in older series [ 26 ] down to 20% or less in more recent reports [ 60 ]. Noteworthy, the percentage of increased LVMI measured by magnetic resonance imaging (a gold standard method for assessing LV mass) [ 14 ] in the HALT-PKD study [ 61 ] involving 558 hypertensive ADPKD patients under pharmacological therapy showed a prevalence of left ventricular hypertrophy (LVH) as low as 0.93%.…”

“…The Chronic Renal Insufficiency Cohort (CRIC) Study [ 65 ] showed an association between the degree of loss of renal function and abnormalities in cardiac structure, mainly higher left ventricular mass, but polycystic kidney disease had been excluded from the trial. Chen et al [ 60 ] observed an inverse correlation between eGFR and LVMI. In the present series, eGFR was not an independent determinant of LVMI by multivariable linear regression.…”