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Regression of left ventricular hypertrophy in hemodialysis patients is possible
H Hampl1, C Sternberg, S Berweck
1Medical Clinic with Emphasis on Nephrology and Intensive Internal Medicine, Humboldt University Berlin, Germany.
Insights
Regression of left ventricular hypertrophy is achievable in hemodialysis patients through comprehensive treatment. Addressing factors like hypertension, anemia, and metabolic issues can significantly improve cardiac health and reduce mortality risk.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Left ventricular hypertrophy (LVH) is a major risk factor for cardiac morbidity and mortality in hemodialysis patients.
- Uremia-associated LVH is multifactorial, necessitating a multi-pronged therapeutic approach.
Purpose of the Study:
- To assess the possibility of regression of left ventricular hypertrophy in hemodialysis patients.
- To evaluate the effectiveness of a comprehensive therapeutic strategy in managing LVH.
Main Methods:
- A cohort of 100 hemodialysis patients was treated with a strategy including optimal control of hypertension, volume status, metabolic acidosis, hypoalbuminemia, hyperparathyroidism, heart failure pharmacotherapy, and anemia correction.
- Echocardiography was used to assess left ventricular mass index (LVMI) over an average of 1.5 years.
Main Results:
- 36 patients maintained normal LVMI, 31 achieved full regression of LVMI, and 33 showed significant improvement.
- 11 patients (33%) with severely increased LVMI did not achieve regression, often due to coexisting severe heart diseases.
- Total correction of renal anemia was strongly recommended as a key factor for LVH regression.
Conclusions:
- Regression and maintenance of normal left ventricular mass index are possible in hemodialysis patients with a comprehensive therapeutic strategy.
- Long-term treatment is necessary for LVH regression, similar to the time required for its development.
- Anemia correction is crucial for achieving significant LVH regression in this population.
Abstract:
Regression of left ventricular hypertrophy in hemodialysis patients is possible. Left ventricular hypertrophy represents the major risk factor for cardiac morbidity and mortality. Therefore, their regression is mandatory. Since the causes of uremia-associated left ventricular hypertrophy are multifactorial, various therapeutic options can be considered: optimal control of arterial hypertension and volume status, optimal correction of metabolic acidosis, best possible correction of hypoalbuminemia and severe secondary hyperparathyroidism, modern pharmacotherapeutic strategy for the treatment of heart failure (use of angiotensin-converting enzyme inhibitors in combination with angiotensin II receptor blockers and beta-blockers) and total correction of renal anemia. Following the proposed therapeutic strategies we could, by using echocardiography, distinguish in 100 hemodialysis patients the following 3 groups (on the average after 1.5 years): 36 patients with initially normal left ventricular mass index (LVMI (g/m2), F < 110; M < 130) maintained normal (group 1); in 31 patients with moderately increased LVMI full regression resulted (group 2); 33 patients with severely increased LVMI (group 3) had to be further divided into 2 sub-groups: 22 patients with significant improvement of LVMI, 11 patients with no, regression. For the first time we were able to show that it is possible to maintain initially normal LVMI during long-term treatment and to achieve complete regression and significant improvement of LVMI in our patients. However, since LVMI requires a long time to develop, a similarly long time must be estimated for its regression. However, 11 patients remained therapeutically resistant. In this group, severe heart diseases were often combined and highly prevalent, including ischemic heart and valve diseases and end-stage dilatative cardiomyopathy. These patients had to be transferred to cardiac surgery. Anemia is considered to be one of the most important factors for the development of left ventricular hypertrophy. Therefore, total correction of renal anemia has to be strongly recommended in addition to other measures of our therapeutic strategy to maintain full or significant regression of left ventricular hypertrophy.