Left ventricular mass index increase in early renal disease: Impact of decline in hemoglobin

Levin, Adeera; Thompson, Christopher R.; Éthier, Jean; Carlisle, Euan; Tobe, Sheldon W.; Mendelssohn, David C.; Burgess, Ellen; Jindal, Kailash; Barrett, Brendan; Singer, Joel; Djurdjev, Ognjenka

doi:10.1016/s0272-6386(99)70118-6

Cited by 738 publications

(479 citation statements)

References 29 publications

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“…The hemodynamic and metabolic disturbances in patients with CKD may synergistically activate a variety of pathophysiological alterations, including hemodynamic abnormalities (that is, increased preload and afterload) and non-hemodynamic abnormalities (that is, neurohormonal stressors and factors promoting myocardial fibrosis and atherosclerosis), and thus result in the excessive growth of the LVM. [1][2][3][4]20 Nardi et al 7 evaluated the prevalence of inappropriate LVM in CKD stage 2-5 patients with a mean eGFR of 39 ml min À1 per 1.73 m 2 and found that patients with CKD had a higher prevalence of inappropriate LVM than hypertensive patients with normal renal function (52.6% vs. 30.5%, Po0.001). Cioffi et al 12 also studied the relationship between inappropriate LVM and renal function in patients with a mean eGFR of 67 ml min À1 per 1.73 m 2 and found that there was an inverse relation between observed/ predicted LVM and eGFR.…”

Section: Discussionmentioning

confidence: 99%

“…Left ventricular systolic function was assessed by the left ventricular ejection fraction (LVEF) and midwall fractional shortening (mwFS). 15 The observed LVM was calculated using the Devereux- 3 ÀLVIDd 3 ] À13.6 g. 16 The left ventricular mass index (LVMI) was calculated by dividing the LVM by the body surface area. Left ventricular hypertrophy (LVH) was defined as suggested by the 2007 European Society of Hypertension/European Society of Cardiology guidelines.…”

Section: Evaluation Of Cardiac Structure and Functionmentioning

confidence: 99%

“…1 This excess cardiovascular risk in CKD can be attributed to several risk factors, such as proteinuria, fluid retention, anemia, oxidative stress and structural and functional abnormalities of the heart. [1][2][3][4] A number of hemodynamic and metabolic disturbances affect the structure and function of the heart in patients with CKD. 5 To compensate for the hemodynamic and metabolic alterations, an excessive increase in the left ventricular mass (LVM), a condition that has been termed 'inappropriate LVM' , is frequently found in patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

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The ratio of observed to predicted left ventricular mass is independently associated with increased cardiovascular events in patients with chronic kidney disease

et al. 2012

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A condition involving the growth of the myocardium that exceeds hemodynamic needs has been reported and called as inappropriate left ventricular mass (LVM). The appropriateness of LVM can be estimated by the ratio of observed LVM to predicted LVM. The excessive growth of LVM is frequently noted in patients with chronic kidney disease (CKD). This study is designed to assess whether the ratio of observed to predicted LVM is a useful prognostic indicator of cardiovascular events in patients with moderate to advanced CKD. We consecutively enrolled 485 patients with CKD stages 3-5 from our Outpatient Department of Internal Medicine. Inappropriate LVM was defined as observed LVM more than 28% greater than the predicted value. The relative risk of cardiovascular events was analyzed by Cox-regression methods. There was a significant trend for a stepwise increase in the observed/predicted LVM ratio (Po0.001) and the prevalence of inappropriate LVM (P ¼ 0.003) corresponding to advances in CKD stages. In the multivariate analysis, old age, a history of coronary artery disease, congestive heart failure, atrial fibrillation, wide pulse pressure, decreased serum albumin and hemoglobin levels, left atrial diameter 44.7 cm and increased observed/predicted LVM were independently associated with increased cardiovascular events. Our findings show that increased observed/predicted LVM is independently associated with adverse cardiovascular outcomes in patients with CKD stages 3-5.

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Section: Discussionmentioning

confidence: 99%

Section: Evaluation Of Cardiac Structure and Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The ratio of observed to predicted left ventricular mass is independently associated with increased cardiovascular events in patients with chronic kidney disease

et al. 2012

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“…Posljednjih decenija postoje brojni podaci o uticaju niskog nivoa hemoglobina u ranim stadijumima hronične bubrežne insuficijencije na nastajanje različitih komorbiditeta, osobito kardiovaskularnih bolesti. Podaci govore da bolesnici koji u predijaliznom periodu nisu primali eritropoetin u terapiji bubrežne anemije imaju veći rizik za nastanak HLK, infarkta i iznenadne smrti [20][21][22]. Niske vrijednosti hemoglobina su povezane sa promjenom strukture, funkcije srca i krvnih sudova, osobito u periodu prije hemodijalize [23][24].…”

Section: Diskusijaunclassified

Uticaj korekcije anemije bolesnika sa hroničnom bubrežnom insuficijencijom na kardiovaskularni sistem

Radović¹,

Kešelj²,

Pejović³

2011

Biomedicinska istraž.

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Kratak sadržajUvod. Anemija je česta komplikacija hronične bubrežne insuficijencije, a njen glavni uzrok je nedovoljno stvaranje eritropoetina. Anemija predstavlja značajan faktor rizika za nastanak kardiovaskularnih bolesti. Cilj rada je bio da se ispita oporavak anemije tokom primjene humanog rekombinovanog eritropoetina kod bolesnika sa hroničnom bubrežnom insuficijencijom u predijaliznom periodu i uticaj korekcije anemije na kardiovaskularne promjene.Metode. U prospektivnoj studiji praćeno je 20 bolesnika (13 muškaraca i sedam žena) sa hroničnom bubrežnom insuficijencijom u predijaliznoj fazi tokom jedne godine. Bolesnici su podijeljeni u tri grupe prema jačini glomerulske filtracije (JGF) i u dvije podgrupe -bolesnici sa i bez dijabetesa. JGF je procjenjena pomoću Cockroft-Gault formule. Težina anemije određivana je na osnovu vrijednosti hemoglobina i hematokrita. Kardiovaskularni status je praćen EKG i EHO pregledima srca na početku studije i poslije godinu dana. Statistička obrada rađena je primjenom Studentov-og t-test, analize varijanse, Pearson-ovog koeficijenta korelacija uz korišćenje programa SPSS 12.Rezultati. Prije započinjanja liječenja anemije kod svih bolesnika vrijednosti hemoglobina (Hb) i hematokrita (Hct) su ukazivale na težak stepen anemije. Bolesnicima je ordiniran eritropoetin-beta. Poslije mjesec dana liječenja kod svih je došlo do statistički značajnog porasta Hb i Hct, a poslije tri mjeseca postignuta je ciljna vrijednost Hb i Hct. U ispitanoj grupi bolesnika, svi su sem jednog, imali značajnu hipertofiju lijeve komore koja je utvđena ehosonografski prije početka ispitivanja. Poslije godinu dana liječenja anemije postignuta je statistički značajna regresija mase lijeve komore (MLK) od 267,2g/m 2 do 212,5g/m 2 pri prosječnoj promjeni koncentracije Hb od 9 g/l na 12,5 g /dl. Kod bolesnika koji nisu imali dijabetes, prosječan Hb bio je 8,9 g /dl i povećao se na 12,2g /dl, a prosječna MLK se smanjila od 293,3 g/1,73 m 2 na 222,9 g/1,73 m 2 , dok je kod dijabetičara prosječna vrijednost Hb porasla sa 9,0 g / dl na 12,6 g /dl, a MLK se smanjila od 231,1 g/1,73 m 2 do 198,1 g/1,73 m 2 .Zaključak. Liječenje eritropoetinom u predijaliznom periodu omogućilo je statistički visoko značajnu korekciju anemije. Oporavak anemije pratilo je smanjenje hipertrofije lijeve komore, smanjenje manifestacija ishemije srca i normalizacija EKG nalaza.Ključne riječi: hronična bubrežna insuficijencija, anemija , eritropoetin, hipertrofija lijeve komore.

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“…[8,9] Previous studies have evaluated the association of kidney function with LVH in patients with advanced disease approaching and requiring dialysis [10,11] as well as patients with earlier stages of disease [8]; LVH has been reported in over one-third of persons with CKD. [9] Diastolic dysfunction has also been studied in small cohorts of CKD patients. [12,13] Renal dysfunction is closely related to prognosis of cardiovascular disease (CVD) and conversely CVD patients often develop acute renal failure: this association is referred to as the cardiorenal connection.…”

Section: Introductionmentioning

confidence: 99%

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

Sidmal¹,

Hp²,

Kc³

2015

Int Jour of Biomed Res

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Background: The chronic kidney disease (CKD) is a major risk factor for coronary artery disease (CAD) and left ventricle systolic dysfunction. Left ventricular (LV) diastolic dysfunction in CKD patients frequently leads to the development of congestive heart failure. The interaction between diastolic dysfunction (DD) and renal function in subjects with preserved systolic function is not well defined. Objective: Our aim was to investigate whether renal insufficiency (RI) is associated with DD among patients with left ventricular ejection fraction (LVEF) > 50%, and to investigate whether there is a correlation between CKD and DD severity. Methods: Eighty four CKD patients, aged 35-79 were examined by standard echocardiography. Subjects were divided into 4 groups depending on their estimated glomerular filtration rate (eGFR: ml/min/BSA) as follows: group 1 (60-89 ml/min/BSA), group 2 (30-59 ml/min/BSA), group 3 (15-29 ml/min/BSA) and group 4 (less than 15 ml/min/BSA), between 1/2/2014 and 30/4/2015. Glomerular filtration rate (GFR) was estimated using the MDRD formula. Patients with impaired relaxation (grade I) were compared to those with pseudonormal (grade II) or restrictive (grade III-IV) DD. Results: Among 84 patients, 23 had GFR 60-89 ml/min/BSA; 16 had GFR 30-59 ml/min/BSA; and 19 had GFR 15-30 ml/min/BSA and 26 had GFR <15 ml/min/BSA. There was a significant correlation between worsening GFR and degree of diastolic dysfunction (DD) assessed by echo. Overall, 40.4% of the participants were female, 22 (26.1 %) had grade I, & 10 (11.9 %) had grade II, 16 (19%) had grade III and 36 (42.8%) had grade IV diastolic dysfunction. Almost all patients had some degree of diastolic dysfunction. With worsening of renal function, there was worsening of diastolic dysfunction seen. In patients with end stage renal disease many had grade IV diastolic dysfunction as compared to patients with early CKD. Grade I and II DD was commonly seen in group 1 and 2. But grade III and IV DD was commonly seen in group 3 and 4. Conclusion: Worsening renal function was associated with greater degree of diastolic dysfunction and adverse clinical outcomes. Our Study indicated a clear and independent association between RI and DD. The severity of RI also tends to correlate with the severity of DD. And that LV diastolic dysfunction was observed even in patients with early stages of chronic kidney dysfunction.

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Left ventricular mass index increase in early renal disease: Impact of decline in hemoglobin

Cited by 738 publications

References 29 publications

The ratio of observed to predicted left ventricular mass is independently associated with increased cardiovascular events in patients with chronic kidney disease

The ratio of observed to predicted left ventricular mass is independently associated with increased cardiovascular events in patients with chronic kidney disease

Uticaj korekcije anemije bolesnika sa hroničnom bubrežnom insuficijencijom na kardiovaskularni sistem

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

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