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Relative overhydration is independently associated with left ventricular hypertrophy in dialysis naïve patients with
Byoung-Geun Han1, Jun Young Lee1, Seung Ok Choi1
1Department of Nephrology, Yonsei University Wonju College of Medicine, Kang-won, Wonju, Korea.
Insights
Fluid overload is linked to left ventricular hypertrophy (LVH) in chronic kidney disease (CKD) patients. Early monitoring of fluid status and cardiac structure is crucial for preventing cardiovascular complications in CKD.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Left ventricular hypertrophy (LVH) is common in chronic kidney disease (CKD), worsening with declining kidney function.
- The complex pathophysiology of LVH in CKD necessitates early risk factor identification and prevention strategies.
- Managing fluid status is key to minimizing cardiovascular complications like LVH in CKD patients.
Purpose of the Study:
- To investigate the association between fluid overload and LVH in patients with stage 5 CKD not on dialysis.
- To identify independent predictors of LVH in this patient population.
Main Methods:
- Retrospective analysis of a prospective cohort of 205 patients with stage 5 CKD (non-dialysis).
- Assessment of relative overhydration/extracellular water (OH/ECW) using bioimpedance spectroscopy.
- Evaluation of associations between fluid balance markers, systolic blood pressure, serum phosphorus, and left ventricular mass index (LVMI).
Main Results:
- Fluid balance markers were significantly higher in patients with LVH.
- Increased OH/ECW correlated with higher LVMI.
- Systolic blood pressure, serum phosphorus, and OH/ECW were independently associated with LVMI.
- OH/ECW was independently associated with LVH.
Conclusions:
- Fluid overload, indicated by OH/ECW, is independently associated with LVH in stage 5 CKD patients.
- Simultaneous cardiac evaluation (echocardiography) and volume status assessment (bioimpedance) are recommended for early-stage CKD patients, even without apparent cardiovascular disease.
Abstract:
Patients with chronic kidney disease (CKD) have a high prevalence of left ventricular hypertrophy (LVH), which increases as kidney function decreases. LVH pathophysiology is complex, making it difficult to generalise its evolution in CKD. Therefore, early detection and prevention of risk factors are critical. Assessment and management of volume status can minimise cardiovascular complications including LVH. We retrospectively investigated the associations between fluid overload and LVH in patients with stage 5 CKD not undergoing dialysis in prospective cohort of 205 patients (age: 59.34 ± 13.51 years; women: 43.4%). All patients, free of intrinsic heart disease, were assessed for relative overhydration/extracellular water (OH/ECW) by bioimpedance spectroscopy. Our results show that markers reflecting fluid balance were significantly higher in the LVH group and as OH/ECW increased, the left ventricular mass index (LVMI) trended higher. Furthermore, our results show that systolic blood pressure, serum phosphorus levels, and OH/ECW were independently associated with LVMI and that OH/ECW was independently associated with LVH. Structural and functional evaluation of the heart using echocardiography and volume status assessment using bioimpedance should be performed simultaneously in patients with early-stage CKD, even in those without evident cardiovascular disease.
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