title: Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study.
abstract: Left ventricular (LV) hypertrophy (LVH) is a risk factor for mortality in patients with end-stage renal disease (ESRD). Whether the attenuation of LVH has a positive effect on survival of patients with ESRD has not been documented. The aim of this study was to determine the effect of parallel treatment of hypertension and anemia on LV mass (LVM) and to determine the effect of LVM changes on survival. A cohort of 153 patients receiving hemodialysis was studied. The duration of follow-up was 54 +/- 37 mo. All patients had echocardiographic determination of LV dimensions and LVM at baseline and regular intervals until the end of the follow-up period. During the study, BP decreased from (mean +/- SD) 169.4 +/- 29.7/90.2 +/- 15.6 to 146.7 +/- 29/78 +/- 14.1 mmHg (P < 0.001), and hemoglobin increased from 8.65 +/- 1.65 to 10.5 +/- 1.45 g/dl (P < 0.001). The LV end-diastolic diameter and mean wall thickness decreased from 56.6 +/- 6.5 to 54.8 +/- 6.5 mm (P < 0.001), and from 10.4 +/- 1.6 to 10.2 +/- 1.6 mm (P < 0.05), respectively. The LVM decreased from 290 +/- 80 to 264 +/- 86 g (P < 0.01). Fifty-eight deaths occurred, 38 attributed to cardiovascular (CV) disease and 20 attributed to non-CV causes. According to Cox analyses after adjustment for age, gender, diabetes, history of CV disease, and all nonspecific CV risk factors, LVM regression positively affected the survival. The hazard risk ratio associated with a 10% LVM decrease was 0.78 (95% confidence interval, 0.63 to 0.92) for all-causes mortality and 0.72 (95% confidence interval, 0.51 to 0.90) for mortality due to CV disease. These results show that a partial LVH regression in patients with ESRD had a favorable and independent effect on patients' all-cause and CV survival.
authors.affiliation: *Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
authors.forename: Gérard M
authors.initials: GM
authors.lastname: London
authors.affiliation: *Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pannier
authors.affiliation: *Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
authors.forename: Alain P
authors.initials: AP
authors.lastname: Guerin
authors.affiliation: *Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Blacher
authors.affiliation: *Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
authors.forename: Sylvain J
authors.initials: SJ
authors.lastname: Marchais
authors.affiliation: *Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Darne
authors.affiliation: *Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Metivier
authors.affiliation: *Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
authors.forename: Hassan
authors.initials: H
authors.lastname: Adda
authors.affiliation: *Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
authors.forename: Michel E
authors.initials: ME
authors.lastname: Safar
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000188:drug therapy; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D016019:Survival Analysis