title: Decline of Renal Function and Progression of Left Ventricular Hypertrophy Are Independently Determined in Chronic Kidney Disease Stages 3-5.
abstract: Invasive and noninvasive methods for evaluating the effects of hemodynamics on progression of left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD) have been proposed. Central aortic pressure (CAP) has been reported to be the best among selected measures of hemodynamics for predicting LVH. However, there are few studies examining the relation between longitudinal changes in CAP and renal dysfunction in patients with CKD.
  
  
  METHODS
  Sixty-seven patients with CKD stages 3-5 (female/male ratio: 26/41, age: 61.5 ± 13.1 years) were followed for 5 years. Before and at the end of the 5-year period, CAP was recorded by an automated tonometric system (HEM-9000 AI; Omron Healthcare, Kyoto, Japan). Second systolic aortic blood pressure (SBP2) was employed as an index of CAP.
  
  
  RESULTS
  Throughout the study, systolic blood pressure (SBP) was well controlled. Renal function followed by estimated glomerular filtration rate (eGFR) gradually worsened as a whole. Ten patients had renal replacement therapy, 3 patients developed cardiovascular diseases and 2 patients were found to have a neoplasm during the 5-year observation period. SBP2 increased from 120 ± 19 to 125 ± 33 mm Hg and eGFR decreased from 38.2 ± 18.2 to 29.5 ± 16.3 ml/min/1.73 m(2); however, these differences did not achieve significance. The left ventricular mass (LVM) index significantly increased from 115.5 ± 10.5 to 131.2 ± 11.7 g/m(2) (p < 0.05). Although the changes in SBP2 and eGFR looked like a mirror image, there was no significant correlation between the two factors. Moreover, multivariate regression analysis did not reveal a close correlation between SBP2 and CKD progression. In contrast to the decline of renal function, the baseline value of SBP2 predicted an increase in the LVM index.
  
  
  CONCLUSIONS
  Worsening of renal dysfunction is not solely dependent on hemodynamics. Other factors might be involved in a complex manner.
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inoue
authors.affiliation: Omron Health Care Co. Ltd., Kyoto, Japan.
authors.forename: Mami
authors.initials: M
authors.lastname: Dogi
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kikuta
authors.affiliation: Department of Nephrology, International University of Health and Welfare, Medical University Hospital, Saitama, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Takenaka
authors.affiliation: Department of Nephrology, Saitama Medical University, Saitama, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Okada
keywords: Blood pressure; Central aortic pressure; Estimated glomerular filtration rate; Pulse wave velocity