Ventricular hypertrophy and cardiovascular mortality in hemodialysis patients with low educational level.
BACKGROUND
Left ventricular hypertrophy is a strong predictor of mortality in chronic kidney patients. A previous study of our group has shown that chronic kidney patients with low educational level has more severe ventricular hypertrophy.


OBJECTIVE
To extend a previous study and to assess whether left ventricular hypertrophy can explain the association between schooling and cardiovascular mortality in hemodialysis patients.


METHODS
This study assessed 113 patients from January 2005 to March 2008 and followed them up until October 2010. Survival curves were built to compare all-cause and cardiovascular mortality of patients with up to three years of schooling (median schooling) and those with schooling of four years and over. Cox multiple models were built and adjusted to confounding variables.


RESULTS
Association between educational level and ventricular hypertrophy was observed. Statistical difference in all-cause and cardiovascular mortality between the different educational levels was observed at 5.5 years of follow-up. In the Cox model, ventricular hypertrophy and C-reactive protein associated with all-cause and cardiovascular mortality. The etiology of kidney failure associated with all-cause mortality, and creatinine associated with cardiovascular mortality. The association between educational level and mortality lost statistical significance in the adjusted model.


CONCLUSIONS
The results of this study confirm those of a previous study. In addition, they show that the higher cardiovascular mortality observed in patients with low educational level can be explained by risk factors of biochemical and cardiac morphological origin.
Departamento de Enfermagem, Faculdade de Medicina de Botucatu, UNESP, SP, Brazil. rmartin@fmb.unesp.br
Rosana Dos Santos E Silva
Rdos S
Martin
Luis Cuadrado
LC
Martin
Roberto Jorge da Silva
RJ
Franco
Pasqual
P
Barretti
Jacqueline Costa Teixeira
JC
Caramori
João Henrique
JH
Castro
Aline de Araújo
Ade A
Antunes
Silméia Garcia
SG
Zanati-Basan
Beatriz Bojikian
BB
Matsubara
Antônio Sérgio
AS
Martins
D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D003404:Creatinine / Q000097:blood*; D004522:Educational Status; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors
D015415:Biomarkers; D002097:C-Reactive Protein; D003404:Creatinine