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Correlation between hypervolemia, left ventricular hypertrophy and fibroblast growth factor 23 in hemodialysis
Suat Unver1, Ela Kavlak2, Hilal Kurtoglu Gümüsel2
1a Department of Dialysis , Istanbul Aydin University , Istanbul , Turkey .
Insights
Fluid overload in hemodialysis patients increases left ventricular hypertrophy (LVH) and FGF23 levels. Controlling interdialytic volume may improve cardiovascular outcomes by reducing these factors.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Left ventricular hypertrophy (LVH) is a major risk factor for cardiovascular complications in hemodialysis (HD) patients.
- Hypervolemia and elevated FGF23 levels are independently associated with increased cardiovascular risk in HD patients.
Purpose of the Study:
- To investigate the correlations between LVH, interdialytic volume changes, and FGF23 levels in patients undergoing chronic hemodialysis.
- To identify risk factors associated with LVH in this patient population.
Main Methods:
- A cohort of 97 chronic hemodialysis patients was analyzed.
- Measurements included Left Ventricular Mass Index (LVMI) via echocardiography, FGF23 levels using ELISA, and interdialytic fluid gain.
- Data on blood pressure, urine output, and clinical parameters were collected.
Main Results:
- Interdialytic volume overload positively correlated with LVMI (r=0.459, p<0.01) and FGF23 levels (r=0.326, p<0.05).
- Elevated FGF23 levels predicted increased LVMI (r=0.322, p<0.01) and interventricular septum thickness (r=0.238, p<0.05).
- Predialysis mean arterial blood pressure, volume overload, and diabetes were independent risk factors for LVMI.
Conclusions:
- Interdialytic volume overload is associated with increased LVMI and FGF23 levels in hemodialysis patients.
- Effective interdialytic volume management may positively impact FGF23 levels and mitigate cardiovascular risks.
Introduction:
Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular complications in hemodialysis (HD) patients. Hypervolemia has been accepted as an independent risk factor for progressive LVH in HD patients. Additionally, high FGF23 levels have been a significant predictor of cardiovascular mortality and morbidity in chronic kidney disease and HD patients. The aim of our study is to investigate the correlation among LVH, interdialytic volume increase and FGF-23 in the patients on a chronic hemodialysis program.
Design And Methods:
A total of 97 chronic hemodialysis patients (64.43 ± 11.28 years old, M/F:47/50) were included in the study. Human FGF-23 ELISA kit was used for FGF-23 analysis of predialysis blood samples. Echocardiographic evaluation was performed in all of the patients after dialysis. Left Ventricular Mass Index (LVMI) was calculated by using the Devereux Formula. We collected the following data: LVMI, FGF-23 levels, interdialytic fluid gain, blood pressure changes, and the other biochemical and clinical parameters.
Results:
Mean LVMI of the patients was 184.41 ± 48.62 g/m(2). LVMI of the patients with daily urine output > 250 mL was found significantly lower. Statistically significant positive correlation was found between predialysis systolic blood pressure, predialysis diastolic blood pressure, predialysis mean arterial blood pressure and LVMI measurements (p < 0.01). Mean interdialytic volume excess was correlated with LVMI measurements of the patients (r = 0.459; p < 0.01). Increased FGF-23 levels (159.79 ± 134.99 ng/L) predicted increased LVMI measurements of the patients (r = 0.322; p < 0.01). In addition, FGF-23 levels were also increased as the interdialytic fluid volume increased (r = 0.326; p < 0.05). A positive correlation was also found between FGF-23 levels and interventricular septum thickness (r = 0.238; p < 0.05). Predialysis mean arterial blood pressure, predialysis volume overload and presence of diabetes were determined to be independent risk factors on LVMI on multivariate regression analysis.
Conclusion:
Our study showed that interdialytic volume overload increased both LVMI and FGF-23 values. We can consider that interdialytic volume control exerts positive effects on increased FGF-23 levels which predict the negative cardiovascular outcomes.
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