The long-term behavior and predictors of left ventricular hypertrophy in hemodialysis patients

The long-term behavior of left ventricular hypertrophy (LVH) was evaluated and potential predictors of change in left ventricular mass index (LVMI) in hemodialysis (HD) patients were determined.

One hundred eight patients on regular HD treatment were included. In addition to hematologic and biochemical evaluations, annual echocardiography and 24-hour ambulatory blood pressure monitoring were performed in all patients. During the median follow-up of 50 months (range, 12 to 63 months), a median of 4 echocardiographic examinations were performed in each patient. The presence of LVH was defined on the basis of an LVMI greater than 131 g/m2 for men and greater than 100 g/m2 for women.

Eighty-two patients (75.9%) had LVH at baseline. LVH status was stable in 64 patients, whereas it changed on at least 1 occasion in the remaining patients (40.7%). LVH disappeared during the first year in 8 patients and beyond the first year of dialysis therapy in an additional 9 patients. An 8.0 +/- 39.6-g/m2 decrease in LVMI was detected between the first and final evaluations. Independent predictors of change in LVMI were C-reactive protein level (P < 0.001), baseline hemoglobin level (P = 0.025), and baseline postdialysis systolic blood pressure (P = 0.003). Twenty-four-hour systolic blood pressure was the only independent predictor of both LVMI (P < 0.001) and LVH (P = 0.001) at baseline. Nighttime systolic blood pressure and C-reactive protein level were found to be independent predictors of final LVMI (P < 0.001 for both). Independent predictors of LVH at the end of the study were 24-hour systolic blood pressure (P = 0.022) and C-reactive protein level (P = 0.003), whereas hemoglobin level had marginal significance (P = 0.051).

Progressive LVH is not inevitable in HD patients. Aggressive treatment against the predictors may result in regression of LVMI and may improve patient outcome.