Water and sodium restriction on cardiovascular disease in young chronic hemodialysis patients

Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in chronic hemodialysis (CHD) patients. It remains unclear whether efforts to correct fluid overload in young CHD can reverse LVH. This prospective single-center cohort study evaluated left ventricular masses index (LVMI) evolution in fluid overloaded young CHD patients with or without water-sodium control.

A total of 106 young patients aged between 22 and 44 years on CHD were enrolled in this prospective, control study. Patients were divided into three groups according to the percentage of interdialytic weight gain (PIDWG (%) = 100% × (predialysis weight-dry weight)/dry weight) at baseline. Thirty-six patients with PIDWG more than 5% received health education to restrict water-sodium intake strictly (Group I). Other 36 patients with comparable fluid status levels (the PIDWG more than 5%) did not receive health education to restrict water-sodium intake strictly (Group II) and those with PIDWG less than 5% (Group III, n = 34) were served as controls. Echocardiographic studies were performed to evaluate LVMI at baseline and then after 1, 3 and 6 months. The total follow-up time was 6 months.

There was no significant difference in clinical data (such as age, gender, aetiology of renal failure and nutritional state, etc.) among the three groups at baseline. At baseline, the prevalence of LVH in Group I, II and III was 75.0%, 72.2% and 55.9%, respectively. LVMI was directly correlated with PIDWG (r = 0.779, P < 0.01). After 6 months, the PIDWG in Group I decreased in mean by (3.77 ± 1.09)%, and LVMI decreased in mean by (27.59 ± 12.15) g/m(2). The prevalence of LVH decreased in mean by 25.0%, and the blood pressure decreased in mean by (14.69 ± 11.50) mmHg/ (7.14 ± 7.51) mmHg. The medication category and total medication frequency of hypotensive drugs significantly decreased in Group I at 6 months. However the urine volume and the levels of serum creatinine and serum albumin in Group I were not significantly different compared to the baseline. The level of LVMI in Group II was significantly increased after 6 months compared with the baseline. After 6 months, the level of LVMI in Group III were not significantly different compared with the baseline.

A high prevalence of LVH was present in young CHD patients, and was associated with fluid overload. Reduction fuild overload with water-sodium control can reverse LVH in young CHD patients.