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The clinical course of left ventricular hypertrophy in dialysis patients
P S Parfrey1, J D Harnett, S M Griffiths
1Division of Nephrology, Memorial University of Newfoundland, St. John's.
Insights
Severe left ventricular hypertrophy is common in dialysis patients, often present from the start of therapy. This condition is persistent and significantly increases the risk of heart failure and mortality.
Area of Science:
- Nephrology
- Cardiology
- Clinical Medicine
Background:
- Left ventricular hypertrophy (LVH) is a common complication in patients with end-stage renal disease (ESRD).
- The progression and clinical impact of LVH in nondiabetic dialysis patients without dilated cardiomyopathy require further investigation.
Purpose of the Study:
- To assess the clinical and echocardiographic outcomes of left ventricular hypertrophy in nondiabetic dialysis patients.
- To determine the association between LVH severity and adverse events, including heart failure and mortality.
Main Methods:
- A prospective study followed 104 nondiabetic dialysis patients without dilated cardiomyopathy for 3-5 years.
- Echocardiography was used to assess left ventricular wall thickness, categorizing patients into normal, mild, and severe hypertrophy groups.
- Clinical outcomes, including hospital admissions for congestive heart failure and survival rates, were recorded.
Main Results:
- 27% of patients presented with severe LVH at baseline, and 87% of these cases were persistent.
- Patients with severe LVH had a significantly higher incidence of congestive heart failure admissions (50%) and a lower 2-year cumulative survival (53%) compared to those with normal or mild LVH.
- Cardiac or cerebrovascular causes accounted for 71% of deaths in the severe LVH group, versus 0% in the normal LVH group (p = 0.001).
Conclusions:
- Severe left ventricular hypertrophy is prevalent and persistent in dialysis patients, often preceding end-stage renal disease therapy.
- LVH is a significant risk factor for congestive heart failure and is strongly associated with increased mortality in this population.
- Early detection and management of LVH are crucial for improving outcomes in dialysis patients.
Abstract:
To determine the clinical and echocardiographic outcome of left ventricular hypertrophy a prospective study was undertaken of 104 nondiabetic dialysis patients without dilated cardiomyopathy, who were followed for 3-5 years. 33% of patients had normal echocardiogram, 41% mild and 27% severe hypertrophy (left ventricular wall thickness greater than or equal to 1.4 cm in diastole). In the first 2 groups 16% progressed to severe hypertrophy, 23% were admitted with congestive heart failure after starting dialysis therapy, and 2-year cumulative survivals were 97 and 85%. In the group with severe hypertrophy 88% already had severe hypertrophy on starting dialysis therapy, it was persistent in 87%, 50% were admitted at least once with congestive heart failure, and the 2-year cumulative survival was 53%. 71% of those who died in the severe group died from cardiac or cerebrovascular causes compared to none of those with normal echocardiogram, which accounted for the significantly worse (p = 0.001) survival. We conclude that severe left ventricular hypertrophy occurs frequently in dialysis patients, is often present at the start of end-stage renal disease therapy, is persistent, may predispose to congestive heart failure, and is associated with a high mortality.