title: Left ventricular hypertrophy as a determinant of renal outcome in patients with high cardiovascular risk.
abstract: OBJECTIVE
  The prognostic importance of left ventricular hypertrophy (LVH) on renal impairment has not been addressed previously. We investigated whether LVH determines renal outcomes in patients with high cardiovascular risk.
  
  
  METHODS
  We retrospectively studied 6163 men with high cardiovascular risk (68 ± 13 years, 23% with coronary artery disease, 34% with diabetes, 83% with hypertension and 30% smokers) followed for a period of 14 years. Left ventricular mass index was assessed at baseline, whereas kidney function and blood pressure levels were determined at both baseline and the end of the follow-up period. Renal outcomes were doubling of serum creatinine, estimated glomerular filtration rate (eGFR) below 30 ml/min per 1.73 m and incident hemodialysis.
  
  
  RESULTS
  During the follow-up, 5.8% (n = 356), 7% (n = 429) and 2.7% (n = 165) of men fulfilled the above-mentioned three outcomes, respectively. After adjustment, for each 42 g/m (1 SD) increase in left ventricular mass index, there was a rise in risk of all renal outcomes by 45.7% (95% confidence interval 28.5-58.3) for doubling of serum creatinine, 51.9% (95% confidence interval 39.7-65%) for eGFR below 30 ml/min per 1.73 m and 58.3% (95% confidence interval 39.7-79.3) for hemodialysis (P < 0.001 for all). Severe LVH (160 < left ventricular mass index ≤ 180 g/m) compared with non-LVH predicted a significant increase in: doubling of serum creatinine by 103.8%, eGFR-guided outcome by 109.1% and hemodialysis by 74.1%. In those with LVH and impaired kidney function at baseline (GFR <60 ml/min per 1.73 m) compared with those without such entities, serum creatinine, eGFR and hemodialysis-guided outcomes were increased by four-fold, 15-fold and 16-fold, respectively.
  
  
  CONCLUSIONS
  Increased left ventricular mass is a predictor of subsequent kidney dysfunction and should be considered in renal risk stratification in a broad spectrum of men with high cardiovascular risk.
authors: Georgetown Medical Centers, Washington, DC, USA. ktsioufis@gmail.com
authors: Costas
authors: C
authors: Tsioufis
authors: Peter
authors: P
authors: Kokkinos
authors: Chris
authors: C
authors: Macmanus
authors: Costas
authors: C
authors: Thomopoulos
authors: Charles
authors: C
authors: Faselis
authors: Michael
authors: M
authors: Doumas
authors: Christodoulos
authors: C
authors: Stefanadis
authors: Vasilios
authors: V
authors: Papademetriou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000473:pathology; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000473:pathology*; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003404:Creatinine