title: Serial echocardiographic changes in patients on hemodialysis: an evaluation of guideline implementation.
abstract: BACKGROUND
  Few studies have addressed the description of serial changes in left ventricular mass (LVM) and relevant risk factors. All these studies were initiated before the implementation of EBPG or K/DOQI guidelines. The aims of our study were to prospectively describe trends in left ventricular (LV) structure and function, evaluate risk factors for progression of LVM derived from serial echocardiographic measurements starting January 2003, 6 months after full implementation of EBPG in our unit.
  
  
  METHODS
  One hundred seventy-six patients were enrolled at baseline, between 1 January 2003 and 1 October 2004; 33 patients were excluded from analysis due to poor echocardiographic window, 14 patients died and 26 were transplanted or transferred during the follow-up period of minimum 12 months. One hundred and three patients were included in the final analysis (mean age 51 years, mean follow-up 24.1 +/- 14.4 months). Echocardiography was performed at inclusion and at the end of study. Biochemical, blood pressure (BP) and medication data were collected and the means of monthly values were used.
  
  
  RESULTS
  At baseline, 86.4% of the patients had left ventricular hypertrophy (LVH) (56.3% concentric hypertrophy, 30.1% eccentric hypertrophy, 6.8% concentric remodeling and only 6.8% normal LV geometry), 25.6% had systolic dy-sfunction and 50.5% had abnormal LV volume index (LVVI). Similar data were recorded at follow-up (82.5%, 44.7%, 37.9%, 7.7%, 9.7%, and 19.5%, respectively). Baseline left ventricular mass index (LVMI) significantly correlated with hemoglobin (Hb) and total protein level. LVMI at follow-up correlated to Hb, SBP, PP, mean level of serum phosphate, calcium x phosphate product and cholesterol. Independent predictors for LVMI (multiple regressions) were anemia and mineral metabolism markers. In our population, 62.1% of the patients had a regression of LVMI, with a mean decrease in LVMI of 12 g/m 2 (1.7 +/- 11.7 g/m 2 /month) over more than 12 months of guideline implementation. Regressors had a significant improvement of anemia, serum phosphate level and calcium x phosphate product (p<0.05).
  
  
  CONCLUSIONS
  Our study suggests that a holistic interventional approach, targeting various pathogenic mechanisms, as per guidelines, can elicit at least a partial regression in LV structural and functional abnormalities in hemodialysis patients.
authors.affiliation: Dialysis and Transplantation Center, 'Dr. C.I. Parhon' University Hospital, Iasi, Romania. acovic@xnet.ro
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.forename: Nicoleta G I
authors.initials: NG
authors.lastname: Mardare
authors.forename: Serban
authors.initials: S
authors.lastname: Ardeleanu
authors.forename: Octavian
authors.initials: O
authors.lastname: Prisada
authors.forename: Paul
authors.initials: P
authors.lastname: Gusbeth-Tatomir
authors.forename: David J A
authors.initials: DJ
authors.lastname: Goldsmith
mesh_terms: D004452:Echocardiography; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects