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Hypoalbuminemia as a risk factor for progressive left-ventricular hypertrophy in hemodialysis patients
1Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Insights
Left-ventricular hypertrophy (LVH) is common in patients starting hemodialysis. Low serum albumin levels were identified as a significant risk factor for the progression of LVH in these patients.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Left-ventricular hypertrophy (LVH) is a significant concern in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis.
- Understanding the progression of LVH and its associated risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate changes in left-ventricular (LV) mass in patients initiating maintenance hemodialysis.
- To identify risk factors contributing to the progression of LVH in this population.
Main Methods:
- Baseline echocardiography was performed on 111 ESRD patients within six months of starting hemodialysis.
- Follow-up echocardiography was conducted on 32 patients with baseline LVH after approximately 15 months.
- LVH was defined by left-ventricular mass index (LVMI); progressive LVH was defined as >105% of baseline LVMI.
Main Results:
- A high prevalence of LVH (82%) was observed in patients starting hemodialysis.
- Progressive LVH occurred in 19 of 32 patients (59%).
- Lower diastolic blood pressure and lower serum albumin levels were associated with progressive LVH; hypoalbuminemia was an independent risk factor.
Conclusions:
- LVH is highly prevalent among ESRD patients initiating maintenance hemodialysis.
- A substantial proportion of patients experienced LVH progression, with hypoalbuminemia identified as a key risk factor.
- Further research into managing hypoalbuminemia may help mitigate LVH progression in dialysis patients.
Background:
This study was performed to evaluate the changes in left-ventricular (LV) mass in the patients starting maintenance hemodialysis and the risk factors for the progression of LVH.
Methods:
From June 1994 to February 1997, baseline echocardiography was obtained within six months after the initiation of hemodialysis in 111 patients with end-stage renal disease. Of the patients who had LVH on baseline echocardiography, 32 patients underwent follow-up echocardiography after 15 months (range: 9-24 months). LVH was defined as a left-ventricular mass index (LVMI) greater than 131 g/m(2) in males and 100 g/m(2) in females. Progressive LVH was defined as a follow-up LVMI greater than 105% of the baseline value. Hemoglobin, blood urea nitrogen, creatinine, cholesterol, albumin, prealbumin, parathyroid hormone, Kt/V, nPCR, fibrinogen, homocysteine and ACE gene polymorphism were also measured.
Results:
LVH was detected in 91 of 111 (82%) ESRD patients starting maintenance hemodialysis. Of the 32 patients in whom follow-up echocardiography was performed, progressive LVH occurred in 19 patients (M:F = 12:7). Progressive LVH was associated with lower diastolic blood pressure (81 +/- 11 vs. 90 +/- 12 mm Hg, p = 0.036) and lower serum albumin (3.5 +/- 0.4 vs. 3.9 +/- 0.4 g/dl, p = 0. 009). Serum albumin was negatively (r = -0.420, p = 0.017) correlated to Delta LVMI (follow-up LVMI minus baseline LVMI). Hypoalbuminemia was an independent risk factor for progressive LVH in multiple logistic regression analysis (R.R. = 1.29, p = 0.046). The association of progressive LVH with age, gender, diabetes mellitus, smoking history or other laboratory parameters was not significant.
Conclusion:
LVH was highly prevalent in the patients starting maintenance hemodialysis for ESRD. In the follow-up echocardiography, LVH progressed in a substantial portion of the patients, and hypoalbuminemia was a risk factor for progressive LVH.