Left ventricular mass regression, all-cause and cardiovascular mortality in chronic kidney disease: a meta-analysis

Abstract

Background Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. Methods The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. Results The meta-analysis included 42 trials with duration ≥12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 12 of other types of interventions. All-cause mortality was reported in 121/2584 (4.86%) subjects in intervention groups and 168/2606 (6.45%) subjects in control groups. The pooled RR estimate of the 27 trials ≥12 months with ≥1 event in ≥1 group was 0.72 (95% CI 0.57 to 0.90, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥6 months (34 trials), ≥9 months (29 trials), and >12 months (10 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.67, 95% CI 0.39 to 1.16. Conclusions These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.

Left ventricular myocardial mass index associated with cardiovascular and renal prognosis in IgA nephropathy

“…In the latest meta-analysis by Maki et al, it was shown that LVM change may be useful as a surrogate marker the for benefits of interventions intended to reduce mortality risk in CKD [ 51 ].…”

Exercise and chronic kidney disease: potential mechanisms underlying the physiological benefits

“…The presence of LVH is an independent predictor of mortality across the CKD spectrum and interventions that induce reductions in LV mass (e.g. exercise programmes, extended dialysis regimens, anaemia control) are associated with significant reductions in the risk of all-cause mortality in patients with CKD 45 . The causes of LVH in CKD are multi-factorial and include factors related to afterload, factors related to preload and non-haemodynamic factors 46 .…”

Roxadustat reduces left ventricular mass index compared to rHuEPO in haemodialysis patients in a randomized controlled trial

“…Second, the follow‐up time of 12 months failed to assess differences in patient outcomes, and there was some uncertainty in using surrogate LVMI as the primary outcome indicator. However, the results of the most recent meta‐analysis suggest that interventions to reduce LVM are associated with a significant reduction in the combined risk of ACM; hence, LVM is a good surrogate indicator [41].…”