The effect of anemia and left ventricular geometric patterns on renal disease progression in type 2 diabetic nephropathy.
BACKGROUND
Left ventricular (LV) geometric patterns have never been evaluated as independent risk factors for renal disease progression (RDP). We investigated the risk factors for RDP in type 2 diabetic nephropathy patients, especially focusing on the effects of LV geometric patterns.


METHODS
This was a single-center retrospective cohort study. Type 2 diabetic nephropathy patients who underwent echocardiography for routine checkup were recruited. Baseline laboratory data within 1 month from the time of echocardiography and clinical and follow-up laboratory data were collected by retrospective reviews.


RESULTS
A total of 150 patients (90 men, mean age 62.9 years) were enrolled. Distributions of the patients according to LV geometric patterns were as follows: normal 21 (14.0%), concentric remodeling 18 (12.0%), concentric hypertrophy 70 (46.7%) and eccentric hypertrophy 41 (27.3%). During the study period (30.1 ± 19.4 months), RDP developed in 53 of 150 patients (35.3%). On univariate analysis, use of erythropoiesis-stimulating agent, hemoglobin, serum creatinine, estimated glomerular filtration rate (eGFR), serum albumin, log-transformed 24-hour urine protein, LV mass index and eccentric hypertrophy were strong predictors of renal outcomes. RDP-free survival was significantly decreased in the eccentric hypertrophy group (p=0.001, vs. other groups) according to Kaplan-Meier analysis. On multivariate analysis, eGFR, eccentric hypertrophy and hemoglobin levels were significant predictors of renal outcome.


CONCLUSIONS
Anemia and eccentric hypertrophy may be considered as important risk factors for RDP. Multicenter prospective trials should be needed to validate the effect of LV geometric patterns on RDP.
Moon
Sung Jin
SJ
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Bae
Ki Sun
KS
Park
Hyeong Cheon
HC
Kim
Jwa Kyung
JK
Park
Jung Tak
JT
Lee
Jung Eun
JE
Rim
Se Joong
SJ
Ha
Sung Kyu
SK
D000740:Anemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D016009:Chi-Square Distribution; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006397:Hematinics / Q000627:therapeutic use; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D017582:Renal Replacement Therapy; D056910:Republic of Korea; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography; D020257:Ventricular Remodeling
D006397:Hematinics; D006454:Hemoglobins