Impact of volume control on left ventricular hypertrophy in dialysis patients.
BACKGROUND
Left ventricular hypertrophy (LVH), which strongly predicts cardiac mortality, is seen in more than 60% of end-stage renal disease patients. The aim of this study was to prospectively investigate the effect of salt restriction and strict volume control on blood pressure and LVH.


METHODS
Nineteen hypertensive patients on chronic hemodialysis (HD) treatment (age 52 +/- 17 years, 7 women) were included in the study. Treatment consisted of 12-h HD per week, during which as much ultrafiltration (UF) was applied as possible without an excessive blood pressure (BP) drop. Special attention was given to dietary salt restriction. Predialysis mean BP (MBP), body weight (BW), cardio-thoracic index (CTI) and echocardiographic results were recorded at baseline and after 6 and 12 months.


RESULTS
All patients reached acceptable BP (< 140/90 mmHg) within three months (10-75 days) with our strict volume control strategy. Mean pre-dialysis BP was 127 +/- 17/78 +/- 9 mm Hg at baseline, 120 +/- 9/75 +/- 6 mm Hg at the 6th month and 118 +/- 11/73 +/- 5 mm Hgat the 12th month. The incidence of symptomatic hypotension gradually decreased from a mean of 22% to 11% and 7%, respectively during follow-up. Left ventricular mass index decreased from 164 +/- 64 to 112 +/- 36 g/m2. CTI, left atrial, left ventricular systolic and diastolic diameters significantly decreased in all patients. Inter-dialytic weight gain was 930 +/- 70 g/day in the follow-up period. Hematocrit did not significantly differ at the first, second and last visits.


CONCLUSIONS
Normal BP and improvement of cardiac structure, in particular a reduction of LVH could be reached in all our patients by intensifying salt restriction and UF.
Ozkahya
Mehmet
M
Department of Nephrology, Ege University Medical Faculty, Bornova, Izmir, Turkey. m.ozkahya@ixir.com
Toz
Huseyin
H
Qzerkan
Filiz
F
Duman
Soner
S
Ok
Ercan
E
Basci
Ali
A
Mees
Evert J Dorhout
EJ
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001795:Blood Pressure Determination; D001835:Body Weight; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004039:Diet, Sodium-Restricted; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000175:diagnosis / Q000628:therapy*; D018570:Risk Assessment; D016896:Treatment Outcome