Regression of left ventricular hypertrophy in hemodialyzed patients is possible: a follow-up study

Few studies have addressed the description of serial changes in left ventricular mass (LVM) and relevant risk factors. The aims of our study were to describe trends in left ventricular (LV) structure and function derived from echocardiographic measurements over a 10-year period in Fresenius Nephrocare Dialysis Center in Iaşi and to compare the results with those obtained on a smaller group 4 years ago.

Three hundred and thirty-four hemodialyzed patients were enrolled at baseline, between January 1999 and March 2009. Echocardiography was performed at inclusion and several times for each patient during this period, until the end of the study. Mean values of the biochemical parameters (hemoglobin, serum proteins, calcium, phosphate) at the time of the echocardiographic examination were calculated and included in the final analysis.

Outcome in dialysis was 70.5% alive at the end of the study. The most important improvement was observed in LV mass index: at the 4th echocardiography, the mean LVMi was 144.8 vs. 156.0 g/m(2) at the 2nd echocardiographic examination vs. 167.2 g/m(2) at the first echocardiographic examination (mean decrease 3.34 ± 9.6 g/m(2)/month). Significant results were obtained by comparing LVMi only in patients with all 4 echocardiographies: left ventricular hypertrophy regression was statistically significant, from 172.7 g/m(2) at the 1st echocardiography to 146.0 g/m(2) at the 4th, i.e. 15.4% reduction of LVMi. Delta LVMi significantly correlated only with changes in hemoglobin (P < 0.05).There was a significant regression of the relative wall thickness from an average of 0.46 to 0.42 (P < 0.05).

Our study proves that regression of LVH in hemodialyzed patients is possible and constitutes a must-achieve objective in dialysis centers.