The Clinical Course of Left Ventricular Hypertrophy in Dialysis Patients

Abstract

To determine the clinical and echocardiographic outcome of left ventricular hypertrophy a prospective study was undertaken of 104 nondiabetic dialysis patients without dilated cardiomyopathy, who were followed for 3–5 years. 33% of patients had normal echocardiogram, 41% mild and 21% severe hypertrophy (left ventricular wall thickness > 1.4 cm in diastole). In the first 2 groups 16%o progressed to severe hypertrophy, 23% were admitted with congestive heart failure after starting dialysis therapy, and 2-year cumulative survivals were 97 and 85%. In the group with severe hypertrophy 88% already had severe hypertrophy on starting dialysis therapy, it was persistent in 87%, 50% were admitted at least once with congestive heart failure, and the 2-year cumulative survival was 53%. 71% of those who died in the severe group died from cardiac or cerebrovascular causes compared to none of those with normal echocardiogram, which accounted for the significantly worse (p = 0.001) survival. We conclude that severe left ventricular hypertrophy occurs frequently in dialysis patients, is often present at the start of end-stage renal disease therapy, is persistent, may predispose to congestive heart failure, and is associated with a high mortality.

Hypertension and the heart

“…Different studies in secondary hypertension found that the presence of LV hypertrophy predicted death in hypertensive patients with end-stage renal disease independent of other factors. [53][54][55] An increased risk for cardiovascular morbid events in patients suffering from coronary artery disease has also been related to the presence of LV hypertrophy. The survival rate in patients with coronary heart disease and LV hypertrophy was decreased compared with the survival rate in those with no evidence of LV hypertrophy.…”

Effects of Residual Renal Function on Left Ventricle and Analysis of Related Factors in Patients with Hemodialysis

“…[1][2][3] During the conservative management of patients undergoing maintenance hemodialysis (MHD), the decrease of the glomerular filtration rate (GFR) was associated with left ventricular hypertrophy (LVH). [4][5][6][7] The presence of LVH, in turn, constitutes an important independent factor of cardiovascular risk in patients with chronic kidney disease (CKD), including MHD patients. Both LVH and systolic dysfunction have major contributions to this increased risk of cardiovascular death.…”

Gene expression in uremic left ventricular hypertrophy: effects of hypertension and anemia

“…The relationship, however, between hypertension and LVH is not so clear in uremia. Whereas some studies showed that prolonged control of hypertension in dialysis patients significantly decreased left ventricular mass (Cannella et al, 1993;Klingbeil et al, 2000), other studies showed that LVH did not change (London et al, 1990;London et al, 1994) or could even progress (Huting et al, 1988;Parfrey et al, 1990) in spite of adequate blood pressure control in uremic patients. Anemia is another common complication in uremia and may also contribute to the pathogenesis of LVH because it is associated with a high output state placing the left ventricle at risk for failure.…”