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Prognostic values of left ventricular mass index progression in incident peritoneal dialysis patients : a prospective
Yun Chen1, Shuqi Dai1, Xiaolin Ge1
1Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China.
Insights
Left ventricular mass index progression in peritoneal dialysis patients predicts mortality and cardiovascular events. Monitoring LVMI helps identify high-risk individuals for better outcomes.
Area of Science:
- Nephrology
- Cardiology
- Clinical Research
Background:
- Left ventricular hypertrophy (LVH) is prevalent in dialysis patients, yet dynamic changes are understudied.
- Left ventricular mass index (LVMI) progression is a critical but rarely discussed structural change in dialysis patients.
Purpose of the Study:
- To assess the prognostic value of LVMI progression in incident peritoneal dialysis (PD) patients.
- To identify risk factors associated with LVMI progression in PD patients.
Main Methods:
- Yearly echocardiography was used to track LVMI changes in incident PD patients over a decade.
- Patients were categorized into LVMI-regression, stable, and progression groups.
- Cox regression and logistic regression models analyzed associations between LVMI progression and mortality/cardiovascular events, and identified risk factors.
Main Results:
- LVMI progression occurred in 33.3% of 216 PD patients.
- LVMI progression independently predicted all-cause mortality (HR 1.419), cardiovascular mortality (HR 1.836), and cardiovascular events (HR 1.494).
- Hemoglobin, ferritin, blood pressure, and fibrinogen were significant risk factors for LVMI progression.
Conclusions:
- Early LVMI progression is a significant independent predictor of mortality and adverse cardiovascular outcomes in PD patients.
- Dynamic monitoring of LVMI can aid in identifying high-risk PD patients.
- Understanding risk factors like hemoglobin and blood pressure is crucial for managing LVMI progression.
Background:
Left ventricular hypertrophy (LVH) is common among patients undergoing dialysis. However, the dynamic structural changes of LV are rarely discussed. The study aimed to investigate the prognostic significance of left ventricular mass index (LVMI)-progression in incident peritoneal dialysis (PD) patients, and explore risks factors for LVMI-progression.
Methods:
Incident PD patients between February 2008 and July 2018 were recruited. Echocardiography was performed yearly to collect LVMI and evaluate its changes. Participants were divided into three subgroups: group with LVMI-regression, group with LVMI stable and group with LVMI-progression. The end points include all-cause mortality, cardiovascular mortality and cardiovascular events. Cox regression models were performed to identify the associations between LVMI-progression and these endpoints. Multivariate logistic regression was conducted to identify risk factors for LVMI-progression.
Results:
A total of 216 PD patients (130 men,60.2%) with a mean age of 54.3 ± 16.8 years were recruited. LVMI-progression was identified in 72 patients (33.3%) after PD initiation. The cohort was followed for a median duration of 65.9 months. Multivariable Cox regression analysis revealed that LVMI-progression was an independent predictor of all-cause mortality (HR, 1.419; 95% CI, 1.016-1.982; p = 0.040), cardiovascular mortality (HR, 1.836; 95%CI, 1.084-3.108; p = 0.024), and cardiovascular events (HR, 1.494; 95%CI, 1.063-2.099; p = 0.021). Multivariable logistic regression showed that hemoglobin, ferritin, blood pressure and fibrinogen were significantly associated with LVMI-progression.
Conclusion:
Early LVMI-progression was independently associated with all-cause mortality and cardiovascular outcomes in PD patients. The dynamic monitoring of LVMI might therefore help identify high-risk patients.
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