[Left ventricular hypertrophy in chronic kidney disease].
Chronic kidney disease (CKD) is associated with increased cardiovascular (CV) risk. Left ventricular (LV) hypertrophy (LVH), together with coronary artery disease, has been considered the main target of intervention. LVH is highly prevalent in CKD even in early stages, as compared to general non-selected population. This is mainly due to the multifactorial pathogenesis of LVH in renal patients where both haemodynamic and non-haemodynamic stimuli synergically act inducing either an increase in left ventricular mass or an LV dilation. Anaemia and arterial hypertension seem to be the most important factors. Interventional studies have shown that partial correction of anaemia through epoetin, together with an arterial hypertension successful therapy through renin-angiotensin system acting drugs, such as ACE-inhibitors, were able to induce a LVH regression in CKD. Indeed, the unfavourable outcome in patients with both CKD and LVH, whose survival is reduced and incidence of fatal and non-fatal CV events increased, can be reversed if LVH is regressed by therapy. The most promising strategy in CKD seems to be LVH early diagnosis through echocardiography, the correct screening of risk factors, a LVM longitudinal monitoring through echo, as well as starting treatment in the early stages of CKD, with the aim of improving general and CV prognosis for these patients.
Paoletti
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Divisione di Nephrologia, Dialisi e Trapianto, Azienda Ospedaliera Universitaria S. Martino, Genova. ernesto.paoletti@hsanmartino.it
Cannella
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D000740:Anemia / Q000150:complications / Q000188:drug therapy; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000209:etiology; D004359:Drug Therapy, Combination; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000627:therapeutic use; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D016030:Kidney Transplantation; D015995:Prevalence; D011994:Recombinant Proteins; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa