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American Journal of Kidney Diseases

Prevalent left ventricular hypertrophy in the predialysis population: Identifying opportunities for intervention

  • Adeera Levin
    Correspondence
    Address reprint requests to Adeera Levin, MD, FRCP(C), Renal Insufficiency Clinic, #602-1160 Burrard St, Vancouver BC, Canada V6Z 1Y6.
    Affiliations
    Divisions of Nephrology and Cardiology, the Departments of Medicine and Health Care and Epidemiology, St Paul's Hospital and the University of British Columbia, Vancouver BC, Canada
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  • Joel Singer
    Affiliations
    Divisions of Nephrology and Cardiology, the Departments of Medicine and Health Care and Epidemiology, St Paul's Hospital and the University of British Columbia, Vancouver BC, Canada
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  • Christopher R. Thompson
    Affiliations
    Divisions of Nephrology and Cardiology, the Departments of Medicine and Health Care and Epidemiology, St Paul's Hospital and the University of British Columbia, Vancouver BC, Canada
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  • Heather Ross
    Affiliations
    Divisions of Nephrology and Cardiology, the Departments of Medicine and Health Care and Epidemiology, St Paul's Hospital and the University of British Columbia, Vancouver BC, Canada
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  • Mary Lewis
    Affiliations
    Divisions of Nephrology and Cardiology, the Departments of Medicine and Health Care and Epidemiology, St Paul's Hospital and the University of British Columbia, Vancouver BC, Canada
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      Abstract

      Left ventricular hypertrophy (LVH) is present in over 70% of patients commencing dialysis. It is an independent risk factor for cardiac death, which is the cause of death in approximately 45% of patients on dialysis. The prevalence of LVH in patients earlier in the course of renal insufficiency is unknown. As part of a prospective longitudinal study evaluating the progression of comorbid diseases in patients with progressive renal disease, we evaluated LVH. In 175 consecutive patients attending a renal insufficiency clinic we obtained technically adequate echocardiograms and estimated left ventricular mass index (LVMI) using two-dimensional targeted M-mode echocardiography. We calculated LVMI using the American Society of Echocardiography cube formula method regressed to anatomic validation. The population consisted of 115 men and 60 women ranging in age from 20 to 82 years (mean age, 51.5 years). The mean creatinine was 403 ± 207 μmol/L (±SD), representing a creatinine clearance (Ccr) of 25.5 ± 17 mL/min. Left ventricular hypertrophy was defined as LVMI greater than 131 g/m2 in men and greater than 100 g/m2 in women, and was present in 38.9% of the population studied. We demonstrate that the prevalence of LVH increases with progressive renal decline: 26.7% of patients with Ccr greater than 50 mL/min had LVH, 30.8% of those with Ccr between 25 and 49 mL/min had LVH, and 45.2% of patients with severe renal impairment (Ccr <25 mL/min) had LVH (P = 0.05). The mean LVMI was significantly different among the three groups (97.5 g/m2 v 100.8 g/m2 v 114.4 g/m2, respectively; P < 0.001). Univariate analyses revealed that age, hemoglobin, systolic blood pressure, and Ccr were significantly different between the groups with and without LVH. The logistic regression model confirmed the findings of the univariate analysis: an increase in age of 5 years was associated with an increase of 3% in risk of LVH (P = 0.0094), as was an increase in systolic blood pressure and for each 5 mL/min decline in Ccr the risk increased by 3% (P = 0.0168). We demonstrate the high prevalence of LVH in patients with renal insufficiency prior to the need for dialysis, which is associated with severity of renal impairment, and identity two modifiable factors (systolic blood pressure anemia) as important predictors of LVH. We suggest that future studies should focus on interventions aimed attenuating the impact of these factors.

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      References

      1. Canadian Organ Replacement Registry, 1991 Report.
        Hospital Medical Records Institute, Don Mills, Ontario, CanadaApril 1993
      2. US Renal Data System: USRDS 1991 Annual Report. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD1991
        • Silberberg JS
        • Barre PE
        • Prichard S
        • Sniderman AD
        Impact of left ventricular hypertrophy on survival in end stage renal disease.
        Kidney Int. 1989; 6: 286-290
        • Foley RN
        • Parfrey PS
        • Harnett JD
        • Kent GM
        • Martin CJ
        • Murray DC
        • Barre PE
        Clinical and echocardiographic disease in patients starting end stage renal disease therapy.
        Kidney Int. 1995; 47: 186-192
        • Parfrey PS
        • Harnett JD
        • Griffiths SM
        • Taylor R
        • Hand J
        • King A
        • Barre PE
        The clinical course of left ventricular hypertrophy in dialysis patients.
        Nephron. 1990; 55: 114-120
        • Devereux RB
        • Pickering TG
        • Alderman MH
        • Chien S
        • Borer JS
        • Laragh JH
        Left ventricular hypertrophy in hypertension: Prevalence and relationship to pathophysiologic variables.
        Hypertension. 1987; 9: 53-60
        • Levy D
        • Garrison RJ
        • Savage DD
        • Kannel WB
        • Castelli WP
        Prognostic implication of echocardiographically determined left ventricular mass in the Framingham Heart Study.
        N Engl J Med. 1990; 322: 1561-1566
        • Cockcroft DW
        • Gault MH
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31-41
        • Greaves SC
        • Gamble G
        • Collins JF
        • Whalley GA
        • Sharpe ND
        Determinants of left ventricular hypertrophy and systolic dysfunction in chronic renal failure.
        Am J Kidney Dis. 1994; 24: 768-776
        • Harnett JD
        • Kent GM
        • Barre PE
        • Taylor R
        • Parfrey PS
        Risk factors for the development of left ventricular hypertrophy in a prospectively followed cohort of dialysis patients.
        J Am Soc Nephrol. 1994; 4: 1486-1490
        • Parfrey PS
        • Griffiths SM
        • Harnett JD
        • Taylor R
        • King A
        • Hand J
        • Barre PE
        Outcome of congestive heart failure, dilated cardiomyopathy, hypertrophic hyperkinetic disease and ischemic heart disease in dialysis patients.
        Am J Nephrol. 1990; 10: 213-221
        • Bernardi D
        • Bernini L
        • Cini G
        • Brandeinilli GA
        • Urit D
        • Bonechi I
        Asymmetrical septal hypertrophy in uremic normotensive patients on regular hemodialysis: An M-mode and 2D echocardiographic study.
        Nephron. 1985; 39: 30-35
        • Sniderman AD
        • Silberberg JS
        • Prichard S
        • Barre PE
        Anemia and left ventricular function in end stage renal disease.
        in: Parfrey P Harnett JD Cardiac Dysfunction in Chronic Uremia. Kluwer Academic, Boston, MA1992: 161-171
        • Harnett JD
        • Parfrey PS
        Blood pressure control and regression of left ventricular hypertrophy in dialysis patients.
        Contrib Nephrol. 1994; 106: 110-113
        • Kupari M
        • Koskinen P
        • Virolainen J
        Correlates of left ventricular mass in a population sample aged 36–37 years: Focus on lifestyle and salt intake.
        Circulation. 1994; 89: 1041-1050
        • Dahlof B
        • Pennert K
        • Hansson L
        Reversal of left ventricular hypertrophy in hypertensive patients: A meta-analysis of 109 treatment studies.
        Am J Hypertens. 1992; 5: 95-110
        • Winearls CG
        • Oliver DO
        • Peppard MJ
        • Reic C
        • Downey MR
        • Cotes PM
        Effect of crythropoietin derived from recombinant DNA on the anemia of patients maintained by chronic hemodialysis.
        Lancet. 1986; 2: 1175-1177
        • London G
        • De Vernejoul MC
        • Fabiani F
        Secondary hyperparathyroidism and cardiac hypertrophy in hemodialysis patients.
        Kidney Int. 1987; 32: 900-907
        • Bourgoignie J
        Progression of renal disease: Current concepts and therapeutic approaches.
        Kidney Int. 1992; 41: S61-S65
        • Dzau VJ
        The role of mechanical and humoral factors in growth regulation of vascular smooth muscle and cardiac myocytes.
        Curr Opin Nephrol Hypertens. 1993; 2: 27-32
        • Ganten D
        • Luft FC
        • Kurokawa K
        Hormones, autocoids, neurotransmitters, and growth factors.
        Curr Opin Nephrol Hypertens. 1993; 2: 1-4
        • Sen S
        Factors regulating myocardial hypertrophy in hypertension.
        Circulation. 1987; 75 (pt 2): I81-I84
        • Wolf G
        • Neilson EG
        Angiotensin II as a renal growth factor.
        J Am Soc Nephrol. 1993; 3: 1531-1540
        • O'Shea M
        • Miller SB
        • Ginkel K
        Roles of growth hormone and growth factors in the pathogenesis and treatment of kidney disease.
        Curr Opin Nephrol Hypertens. 1993; 2: 67-72
        • Burt RK
        • Bupta-Burt S
        • Suki WN
        • Barcenas CG
        • Gerguson JJ
        • Van Buren CT
        Reversal of left ventricular dysfunction after renal transplantation.
        Ann Intern Med. 1989; 111: 635-640
        • Himelman RB
        • Landzberg JS
        • Simonson JS
        • Amend W
        • Bouchard A
        • Merz R
        • Schiller NB
        Cardiac consequences of renal transplant: Changes in LV morphology and function.
        J Am Coll Cardiol. 1988; 12: 915-929
        • Mall G
        • Rambausek M
        • Neumeister A
        • Kollman S
        • Vetterlein F
        • Ritz E
        Myocardial interstitial fibrosis in experimental uremia—Implication for cardiac compliance.
        Kidney Int. 1988; 33: 804-811