title: Cross-sectional association of volume, blood pressures, and aortic stiffness with left ventricular mass in incident hemodialysis patients: the Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) study.
abstract: BACKGROUND
  Higher left ventricular mass (LV) strongly predicts cardiovascular mortality in hemodialysis patients. Although several parameters of preload and afterload have been associated with higher LV mass, whether these parameters independently predict LV mass, remains unclear.
  
  
  METHODS
  This study examined a cohort of 391 adults with incident hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study. The main exposures were systolic and diastolic blood pressure (BP), pulse pressure, arterial stiffness by pulse wave velocity (PWV), volume status estimated by pulmonary pressures using echocardiogram and intradialytic weight gain. The primary outcome was baseline left ventricular mass index (LVMI).
  
  
  RESULTS
  Each systolic, diastolic blood, and pulse pressure measurement was significantly associated with LVMI by linear regression regardless of dialysis unit BP or non-dialysis day BP measurements. Adjusting for cardiovascular confounders, every 10 mmHg increase in systolic or diastolic BP was significantly associated with higher LVMI (SBP β = 7.26, 95 % CI: 4.30, 10.23; DBP β = 10.05, 95 % CI: 5.06, 15.04), and increased pulse pressure was also associated with higher LVMI (β = 0.71, 95 % CI: 0.29, 1.13). Intradialytic weight gain was also associated with higher LVMI but attenuated effects after adjustment (β = 3.25, 95 % CI: 0.67, 5.83). PWV and pulmonary pressures were not associated with LVMI after multivariable adjustment (β = 0.19, 95 % CI: -1.14, 1.79; and β = 0.10, 95 % CI: -0.51, 0.70, respectively). Simultaneously adjusting for all main exposures demonstrated that higher BP was independently associated with higher LVMI (SBP β = 5.64, 95 % CI: 2.78, 8.49; DBP β = 7.29, 95 % CI: 2.26, 12.31, for every 10 mmHg increase in BP).
  
  
  CONCLUSIONS
  Among a younger and incident hemodialysis population, higher systolic, diastolic, or pulse pressure, regardless of timing with dialysis, is most associated with higher LV mass. Future studies should consider the use of various BP measures in examining the impact of BP on LVM and cardiovascular disease. Findings from such studies could suggest that high BP should be more aggressively treated to promote LVH regression in incident hemodialysis patients.
authors.affiliation: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. estherdw.kim@mail.utoronto.ca.
authors.forename: Esther D
authors.initials: ED
authors.lastname: Kim
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. ssozio@jhmi.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. ssozio@jhmi.edu.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Sozio
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. mestrel1@jhmi.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. mestrel1@jhmi.edu.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. bjaar@jhmi.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. bjaar@jhmi.edu.|Nephrology Center of Maryland, Baltimore, Maryland, USA. bjaar@jhmi.edu.
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. tshafi@jhmi.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. tshafi@jhmi.edu.
authors.forename: Tariq
authors.initials: T
authors.lastname: Shafi
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. lmeoni@jhmi.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. lmeoni@jhmi.edu.|Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. lmeoni@jhmi.edu.
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Meoni
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. wkao@jhsph.edu.|Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. wkao@jhsph.edu.|Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. wkao@jhsph.edu.
authors.forename: Wen Hong Linda
authors.initials: WH
authors.lastname: Kao
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. jlima@jhmi.edu.
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.affiliation: Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. rulan.parekh@sickkids.ca.|Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. rulan.parekh@sickkids.ca.|Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. rulan.parekh@sickkids.ca.|Department of Pediatrics and Medicine, School of Medicine, University of Toronto, Toronto, Ontario, Canada. rulan.parekh@sickkids.ca.|Hospital for Sick Children, University Health Network and University of Toronto, Toronto, ON, Canada. rulan.parekh@sickkids.ca.
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D001794:Blood Pressure; D001810:Blood Volume; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011237:Predictive Value of Tests; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D006435:Renal Dialysis; D012307:Risk Factors; D059289:Vascular Stiffness; D015430:Weight Gain