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Left ventricular hypertrophy as a risk factor for arrhythmias in hemodialysis patients
M A Saragoça1, M E Canziani, J L Cassiolato
1Hypertension-Nephrology Division, Escola Paulista de Medicina, São Paulo, Brazil.
Insights
Left ventricular hypertrophy (LVH) is highly prevalent in chronic renal failure patients undergoing hemodialysis. Increased cardiac mass and prolonged dialysis duration are key risk factors for developing ventricular arrhythmias (VAs).
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Chronic renal failure (CRF) patients on hemodialysis exhibit a high prevalence of left ventricular hypertrophy (LVH).
- LVH is a known risk factor for cardiac complications, including ventricular arrhythmias (VAs).
Purpose of the Study:
- To investigate the association between left ventricular hypertrophy (LVH) and the occurrence of ventricular arrhythmias (VAs) in patients with chronic renal failure (CRF) undergoing chronic hemodialysis.
- To identify risk factors contributing to the development of VAs in this patient population.
Main Methods:
- Eighty-one patients with CRF on chronic hemodialysis were assessed.
- Two-dimensional echocardiography and electrocardiogram Holter monitoring were utilized.
- Cardiac mass, prevalence of LVH and VAs, and potential influencing factors (potassium, oxygen levels, dialysis duration) were analyzed.
Main Results:
- A high prevalence of LVH (93%) was observed, irrespective of hypertension status.
- Ventricular arrhythmias (VAs) were present in 48% of patients.
- Increased cardiac mass and prolonged hemodialysis treatment (over 34 months) were significantly associated with severe VAs. Low potassium and oxygen levels during dialysis did not show a significant association with severe VAs.
Conclusions:
- Left ventricular hypertrophy is a significant finding in CRF patients on hemodialysis and is linked to ventricular arrhythmias.
- Increased cardiac mass and extended hemodialysis duration are critical risk factors for severe ventricular arrhythmias in this cohort.
- Monitoring and management of LVH and dialysis duration are crucial for preventing VAs in CRF patients.
Abstract:
The contribution of left ventricular hypertrophy in determining ventricular arrhythmias (VAS) was studied in 81 chronic renal failure patients in chronic hemodialysis using two-dimensional echocardiographic and electrocardiogram Holter monitoring. The prevalence of LVH was 93% (96% in hypertensive and 87% in normotensive patients). The prevalence of VA was 48%. These arrhythmias were associated with increased cardiac mass, lack of potassium supplementation to the hemodialysis bath, and low K+ and PaO2 during dialysis. Severe forms of VA occurred in 19 of 78 patients, and the risk factors for this occurrence were (a) largely increased cardiac mass indices (exceeding in more than 40% the upper limit of normal for each sex) and (b) prolonged periods of time in hemodialysis treatment (34 +/- 5.5 vs. 17 +/- 2.7 months, p less than 0.05). Changes in potassium or oxygen content of the blood were not significantly associated with the occurrence of severe forms of VA.