Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study.
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.
London
Gérard M
GM
*Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
Pannier
Bruno
B
*Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
Guerin
Alain P
AP
*Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
Blacher
Jacques
J
*Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
Marchais
Sylvain J
SJ
*Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
Darne
Bernadette
B
*Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
Metivier
Fabien
F
*Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
Adda
Hassan
H
*Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
Safar
Michel E
ME
*Service d'Hemodialyse, Hôpital F.H. Manhès, Fleury-Mérogis, and Service de Médecine Interne, Hôpital Broussais, Paris, France.
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