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Is regression of left ventricular hypertrophy in maintenance hemodialysis patients possible?

Maurizio Bossola1, Luigi Tazza, Carlo Vulpio

  • 1Hemodialysis Unit, Department of Surgery, Catholic University, Rome, Italy. maubosso@tin.it

Seminars in Dialysis
|September 4, 2008
PubMed

Insights

Left ventricular hypertrophy (LVH) in dialysis patients, once thought irreversible, may regress with interventions like anemia control and hemodialysis. Further controlled studies are needed to confirm optimal treatment strategies for end-stage renal disease patients.

Area of Science:

  • Nephrology
  • Cardiology

Background:

  • Left ventricular hypertrophy (LVH) affects 70-80% of dialysis patients.
  • LVH is linked to poor outcomes and previously considered irreversible.
  • Causes include hypertension, volume overload, and metabolic changes.

Purpose of the Study:

  • To review therapeutic strategies for regressing LVH in end-stage renal disease (ESRD) patients on chronic hemodialysis (HD).
  • To assess the evidence supporting various interventions for LVH regression.

Main Methods:

  • Review of recent studies on LVH regression in ESRD patients.
  • Analysis of therapeutic strategies including anemia control, volume management, antihypertensives, hemodialysis variations, and phosphate/vitamin D treatment.

Main Results:

  • Numerous studies suggest LVH regression is possible with interventions.
  • Therapeutic options include anemia and volume control, antihypertensives, hemodialysis, and managing hyperphosphatemia/vitamin D.
  • Most studies have limitations: small sample sizes, single-arm designs, or lack of randomization.

Conclusions:

  • LVH in ESRD patients on chronic HD may be reversible.
  • Current evidence is largely based on limited studies.
  • More robust, randomized controlled trials are essential to establish optimal treatment protocols for LVH in this population.

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