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      Changes of the Cardiac Architectures and Functions for Chronic Hemodialysis Patients with Dry Weight Determined by Echocardiography

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          Abstract

          Background/Aims: Left ventricular hypertrophy (LVH) has long been known as an independent risk factor for cardiovascular deaths, in both dialysis and general populations. Numerous factors influence the pathophysiology of LVH. However, extracellular fluid may have a particularly important influence on this impact. Inferior vena cava diameter (IVCD) estimation is a non-invasive and relatively convenient method for obtaining a good correlation with the intravascular fluid status, and may obtain an optimal dry weight (DW) for chronic hemodialysis patients. This study estimates the DW of end-stage renal disease (ESRD) patients by echocardiographic measurement of the IVCD to observe changes in cardiac morphology and function. Methods: A total of 88 patients, ranging from 26 to 90 (59.4 ± 13.3) years of age, were involved in this study. The patients were divided into study (n = 48) and control (n = 40) groups. All patients received IVCD assessment via echocardiography bi- monthly for 1 year. In the study group patients, DW was adjusted according to the IVCD by echocardiography. Meanwhile, in the control group patients, DW was adjusted based on traditional clinical parameters. All patients underwent cardiac examinations and measurements, including left ventricular mass (LVM), wall thickness, chamber size and left ventricular systolic function by echocardiography, at the beginning and end of the study. Results: Both groups displayed comparable clinical and biochemical parameters. The IVCD index correlated well with the cardiac parameters estimated by echocardiography. The LVM and left ventricular mass index (LVMI) was reduced significantly in the study group patients (from 200 ± 64.2 to 187 ± 63.2 g, p = 0.021; from 132 ± 37.6 to 123 ± 37.3 g/m<sup>2</sup>, p = 0.014, respectively). Furthermore, the study group patients with fluid overload, named study subgroup A, displayed significant differences not only in LVM and LVMI, but also in septal wall thickness, left ventricular end-diastolic dimension and left atrial dimension. In contrast, the control group displayed no changes in these cardiac architectures during the study period. Conclusion: Adjusting DW via the IVCD measured by echocardiography for hemodialysis patients may prevent the progression of chamber dilatation and LVH, especially for patients with fluid overload.

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          Most cited references 11

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          Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention.

          Left ventricular hypertrophy (LVH) is present in over 70% of patients commencing dialysis. It is an independent risk factor for cardiac death, which is the cause of death in approximately 45% of patients in dialysis. The prevalence of LVH in patients earlier in the course of renal insufficiency is unknown. As part of a prospective longitudinal study evaluating the progression of comorbid diseases in patients with progressive renal disease, we evaluated LVH. In 175 consecutive patients attending a renal insufficiency clinic we obtained technically adequate echocardiograms and estimated left ventricular mass index (LVMI) using two-dimensional targeted M-mode echocardiography. We calculated LVMI using the American Society of Echocardiography cube formula method regressed to anatomic validation. The population consisted of 115 men and 60 women ranging in age from 20 to 82 years (mean age, 51.5 years). The mean creatinine was 403 +/- 207 micro mol/L (+/-SD), representing a creatinine clearance (Ccr) of 25.5 +/- 17 mL/min. Left ventricular hypertrophy was defined as LVMI greater than 131 g/m(2) in men and greater than 100 g/m(2) in women, and was present in 38.9% of the population studied. We demonstrate that the prevalence of LVH increased with progressive renal decline: 26.7% of patients with Ccr greater than 50 mL/min had LVH, 30.8% of those with Ccr between 25 and 49 mL/min had LVH, and 45.2% of patients with severe renal impairment (Ccr <25 L/min) had LVH (P = 0.05). The mean LVMI was significantly different among the three groups (97.5 g/m(2) v 114.4 g/m(2), respectively; P < 0.001). Univariate analyses revealed that age, hemoglobin, systolic blood pressure and Ccr were significantly different between the groups with and without LVH. The logistic regression model confirmed the findings of the univariate analysis: an increase in age of 5 years was associated with an increase of 3% in risk of LVH (P = 0.0094), as was an increase in systolic blood pressure of 5 mm Hg (P = 0.0018). For each 10 g/L decrease in hemoglobin, the risk of LVH increased by 6% (P = 0.0062), and for each 5 mL/min decline in Ccr the risk increased by 3% (P = 0.0168). We demonstrate the high prevalence of LVH in patients with renal insufficiency prior to the need for dialysis, which is associated with severity of renal impairment, and identify two modifiable factors (systolic blood pressure and anemia) as important predictors of LVH. We suggest that future studies should focus on interventions aimed at attenuating the impact of these factors.
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            Impact of left ventricular hypertrophy on survival in end-stage renal disease.

            We examined the prognostic significance of left ventricular hypertrophy determined by echocardiography in a cohort beginning renal replacement therapy. No patient had hemodynamically significant valvular disease or echocardiographic signs of obstructive cardiomyopathy. Using the Cox proportional hazards model, left ventricular hypertrophy was significantly associated with survival. The relative risk, based on comparison of upper and lower quintiles of left ventricular mass index, was 3.7 (95% confidence intervals, 1.6 to 8.3) for all-cause mortality and 3.7 (95% confidence intervals, 1.2 to 11.1) for cardiac mortality. The independent risk, adjusted for age, known coronary artery disease, diabetes, level of systolic blood pressure, and treatment (dialysis or transplantation), was 2.9 (95% confidence intervals, 1.3 to 6.9) for all-cause mortality and 2.7 (95% confidence intervals, 0.9 to 8.2) for cardiac mortality. Therefore, left ventricular hypertrophy appears to be an important, independent, determinant of survival in patients receiving therapy for end-stage renal failure.
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              Left ventricular mass index increase in early renal disease: Impact of decline in hemoglobin

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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2004
                June 2004
                02 September 2004
                : 22
                : 4
                : 351-359
                Affiliations
                aDivision of Cardiology, Chiayi Chang Gung Memorial Hospital, and Divisions of bCardiology and cNephrology, Li-Shin Hospital, Pu-TZ City, Chai Yi Hsien, Taiwan
                Article
                80031 Blood Purif 2004;22:351–359
                10.1159/000080031
                15297785
                © 2004 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, Tables: 3, References: 26, Pages: 9
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/80031
                Categories
                Original Paper

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