Contributive factors to cardiovascular hypertrophy in renal failure

Cardiovascular diseases are the leading cause of morbidity and mortality among end-stage renal disease (ESRD) patients. This is related to the accumulation of nonspecific cardiovascular risk factors in this population, aggravated by some specific features, proper to chronic uremia. The principal abnormalities observed in ESRD patients, with no history of cardiovascular disease, consist in an increased left ventricular mass and a chronic left ventricular dilation. The enlargement of the ventricular cavities is due to a chronic flow overload in which the anemia and dialysis arteriovenous fistula play a dominant role. The increase in ventricular mass is usually less pronounced than the ventricular dilation and for a given arterial pressure the ventricular mass-to-volume ratio is inadequately low. The "inadequate" cardiac hypertrophy is more frequently observed in patients with severe secondary hyperparathyroidism and results in a chronic increase in ventricular stress and oxygen consumption. On the other hand, ESRD patients with aluminum overload exhibit an increased ventricular mass which compensates for ventricular dilation. The echocardiographic indices of ventricular systolic function are normal, contrasting with a pronounced impairment of diastolic properties. The impairment of ventricular filling is in part related to the increased left ventricular mass.