Left ventricular mass and hemodynamic overload in normotensive hemodialysis patients

Lin, Yang; Chen, Chen Huan; Yu, Wen Chung; Hsu, Tsei Lieh; Ding, Philip Yu‐An; Wu, Yang Chang

doi:10.1046/j.1523-1755.2002.00610.x

Cited by 29 publications

(23 citation statements)

References 37 publications

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“…Both cohorts demonstrated an increase in LVMi (Figures 2b and 2c) that was not prevented by EPO therapy. These results are consistent with the belief that hemodialysis is a state of hemodynamic and metabolic perturbation which predisposes to LVH (17,33).…”

Section: Discussionsupporting

confidence: 91%

Erythropoietin Therapy and Left Ventricular Mass Index in CKD and ESRD Patients

Parfrey¹,

Lauve²,

Latrémouille-Viau³

et al. 2009

Clinical Journal of the American Society of Nephrology

109

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Background and objectives: The purpose was to evaluate changes in the left ventricular mass index (LVMi) among anemic chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients treated with recombinant human erythropoietin (EPO).Design, setting, participants, & measurements: A systematic review of the literature, reporting LVMi for patients before and after EPO therapy, was performed. The change in LVMi from baseline to the end of treatment was calculated and stratified by severity of anemia at baseline, target hemoglobin (Hb), and stage of kidney disease.Results: Fifteen eligible studies involving 1731 patients were identified. Cohorts with severe anemia at baseline (<10 g/dl), when given EPO using a lower target level (Hb < 12 g/dl or Hct < 36%) experienced significant reductions in LVMi (؊32.7 g/m 2 ; 95% CI: ؊49.4 to ؊16.1, P < 0.05). However, these studies lacked control groups. Cohorts with moderate anemia at baseline showed insignificant changes in LVMi: 5.3 g/m 2 (95% CI: ؊0.8 to 11.3) for patients assigned to a lower target, and ؊6.6 g/m 2 (95% CI: ؊17.2 to 4.0) for patients assigned to a higher target (Hb > 12 g/dl or Hct > 36%). The effect size was similar in direction for both CKD and ESRD cohorts.Conclusions: Aggregated results from multiple studies suggest that in severe anemia conventional Hb targets for EPO therapy are associated with a reduction in LVMi, but that in moderate anemia target Hb above 12 g/dl does not have a significant beneficial impact on LVMi compared with conventional targets.

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Section: Discussionsupporting

confidence: 91%

Erythropoietin Therapy and Left Ventricular Mass Index in CKD and ESRD Patients

Parfrey¹,

Lauve²,

Latrémouille-Viau³

et al. 2009

Clinical Journal of the American Society of Nephrology

109

View full text Add to dashboard Cite

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“…13,14 The right common carotid artery diameter at diastole and the intimal-medial thickness of the posterior wall were measured from the 2D echocardiographic images. 11 Various aspects of the function of large arteries were indexed by the trunk pulse wave velocity, 11 aortic compliance (AC), effective arterial elastance (E a ), and carotid augmentation index (AI). 11 AC was the ratio of SV to pulse pressure.…”

Section: Cardiac and Vascular Structure And Functionmentioning

confidence: 99%

“…11 Various aspects of the function of large arteries were indexed by the trunk pulse wave velocity, 11 aortic compliance (AC), effective arterial elastance (E a ), and carotid augmentation index (AI). 11 AC was the ratio of SV to pulse pressure. 15 E a was the ratio of end-systolic pressure (P es ) to SV.…”

Section: Cardiac and Vascular Structure And Functionmentioning

confidence: 99%

Volume Status and Blood Pressure During Long-Term Hemodialysis

Chen

Lin

et al. 2003

Hypertension

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Abstract-The importance of volume status on blood pressure in hemodialysis patients has long been recognized. We hypothesized that the enhanced volume dependency of blood pressure is partly determined by ventricular stiffness at end systole. A total of 115 long-term hemodialysis patients were invited to receive a comprehensive, noninvasive cardiovascular examination. End-systolic elastance was determined by using a novel, noninvasive echo-Doppler technique. The positive ratios of the interdialytic systolic blood pressure change vs weight gain during the subsequent 25 hemodialysis sessions were averaged to obtain the volume sensitivity index (mm Hg/kg). H ypertension is present in Ϸ80% to 90% of patients by the time chronic renal failure progresses to end-stage renal disease (ESRD) and is one of the major risk factors that contributes to the development of cardiovascular disease in patients undergoing dialysis. 1,2 A rational approach to this issue necessitates insight into the mechanisms that underlie hypertension in renal failure. 1 Volume expansion has long been considered the most important factor in the development and maintenance of hypertension in ESRD. 1,2 It is well accepted that hypertension can be controlled by adequate dialysis and the maintenance of dry weight in 85% to 90% of dialysis patients. In one center in Tassin, France, almost 98% of the patients were normotensive while receiving no medication by long, slow dialysis. 3,4 In contrast, Ϸ50% of hypertensive patients without renal function impairment are considered salt-sensitive and respond to diuretic therapy alone. 5,6 Thus, it is obvious that the sensitivity of blood pressure change to volume expansion or removal in patients with ESRD is increased compared with hypertensive patients with normal renal function. The mechanisms by which volume expansion leads to an elevation in blood pressure are conventionally attributed to an increase in cardiac output and an inappropriately high systemic vascular resistance. 1 We have demonstrated that arterial stiffening with age is matched by ventricular systolic stiffening, indexed by the end-systolic pressure-volume relation (ie, left ventricular end-systolic elastance, E es ). 7 The two effects contribute to elevating systolic blood pressure (SBP) sensitivity to acutely altered chamber filling 7 and might explain the enhanced pressure lability with diuretics and postural shifts in the elderly. Although E es implies the sensitivity of SBP to acute volume reduction, it is unknown whether E es also predicts changes in SBP with long-term volume change. On the other hand, increased arterial stiffness as a hemodynamic overload with consequential and parallel cardiac and vascular adapta-

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“…Consistent with the literature, we also found that LVMI is positively related to PWV. 30,34,35 High aortic PWV is associated with increased aortic stiffness and increased LVH. Covic et al 36 found an open association between aortic stiffness determined by aortic-femoral PWV and LVM.…”

Section: Discussionmentioning

confidence: 99%

Factors Related to Pulse Wave Velocity and Augmentation Index in Chronic Hemodialysis Patients

et al. 2011

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Background: Augmentation index (AIx) and pulse wave velocity (PWV) are early markers of atherosclerotic vascular changes and also have been shown to be predictive of cardiovascular disease and total mortality. The aim of our study was to evaluate the relationship between PWV and AIx-HR75, which is the corrected form of AIx according to a heart rate of 75 beats/min, echocardiographic parameters and biochemical parameters in chronic hemodialysis (HD) patients. Subjects and methods: AIx-HR75 and PWV were measured in 556 HD patients by applanation tonometry using the SphygmoCor device. Results: The mean PWV and AIx-HR75 values of the study group were 10.2 ± 2.4 and 28.4 ± 10.2 m/s. A positive correlation was found between PWV and AIx-HR75 (r = 0.214, p = 0.000). AIx-HR75 correlated with age (r = 0.093, p = 0.028), body surface area (BSA) (r = −0.194, p = 0.000), mean arterial pressure (MAP) (r = 0.335, p = 0.000), pulse pressure (PP) (r = 0.212, p = 0.000), cardiothoracic index (r = 0.155, p = 0.016), and presence of left ventricular hypertrophy (r = 0.152, p = 0.001). PWV correlated with MAP (r = 0.208, p = 0.000), PP (r = 0.098, r = 0.021), left ventricular mass (r = 0.105, p = 0.023), and predialysis sodium level (r = −0.105, p = 0.023). In the multivariate analyses, PWV was associated with MAP (t = 3.78, p = 0.000), presence of diabetes (t = 3.20, p = 0.001), and predialysis sodium level (t = −2.06, p = 0.040), and AIx-HR75 was associated with age (t = 2.48, p = 0.014), female sex (t = 3.98, p = 0.000), BSA (t = −2.15, p = 0.033), and MAP (t = 7.02, p = 0.000). Conclusion: There is a strong association between MAP and arterial stiffness parameters in HD patients. We feel that efficient control of blood pressure could lead to reduced arterial stiffness in HD patients.

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Left ventricular mass and hemodynamic overload in normotensive hemodialysis patients

Abstract: The NTHD patients, without significant pressure and volume overload, still had increased LVM that was partially explained by the persistent flow overload and subclinical LV dysfunction.

Cited by 29 publications

References 37 publications

Erythropoietin Therapy and Left Ventricular Mass Index in CKD and ESRD Patients

Erythropoietin Therapy and Left Ventricular Mass Index in CKD and ESRD Patients

Volume Status and Blood Pressure During Long-Term Hemodialysis

Factors Related to Pulse Wave Velocity and Augmentation Index in Chronic Hemodialysis Patients

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