BACKGROUND: Although left ventricular hypertrophy (LVH) is a strong predictor of mortality in patients with end-stage renal disease, few studies are available before the start of dialysis treatment. The purpose of this study is to evaluate the prevalence and clinical correlates of LVH in nondiabetic patients with chronic kidney disease (CKD) not yet undergoing renal replacement therapy. METHODS: We investigated 244 nondiabetic patients with CKD; 57 patients (42 men; age, 20 to 78 years) had stages 1 to 2 CKD and 187 patients (122 men; age, 18 to 77 years) had stages 3 to 5 CKD. Fifty-two normotensive healthy subjects served as controls. Each patient had blood pressure (BP) measured by means of 24-hour ambulatory BP monitoring and left ventricular mass index (LVMi) assessed by means of M-mode echocardiography. Creatinine clearance was estimated by means of the Cockcroft-Gault formula, and hemoglobin, serum lipid, and intact parathyroid hormone concentrations and daily urinary protein excretion were assessed by using routine methods. RESULTS: In the overall group, prevalences of arterial hypertension and LVH were 66% and 74%, respectively. LVMi was 160 +/- 50 g/m2 body surface area and associated directly with age (P = 0.0013), duration of arterial hypertension (P = 0.0075), 24-hour systolic BP (P = 0.0113), pulse pressure (P = 0.0003), daytime (P = 0.0206) and nighttime systolic BP (P = 0.0059), and urinary protein excretion (P < 0.05) and inversely with creatinine clearance (P = 0.0103) and hemoglobin level (P = 0.0276). In patients with CKD stages 1 to 2 (LVH prevalence, 51%), age, duration of arterial hypertension, pulse pressure, and urinary protein excretion were significant predictors of LVMi (P < 0.00002) by using stepwise regression analysis, whereas in those with CKD stages 3 to 5 (LVH prevalence, 78%), pulse pressure emerged as the sole predictor of LVMi (P = 0.0011). CONCLUSION: The prevalence of LVH in nondiabetic predialysis patients with CKD is greater than previously reported, and there is evidence that LVH already is present in the early stages of renal disease. Arterial hypertension is associated with LVH in patients with CKD, and the strong relationship between elevated pulse pressure and LVH in those with more advanced CKD suggests that increased arterial stiffness might have a role for LVH well before the start of dialysis therapy.
BACKGROUND: Although left ventricular hypertrophy (LVH) is a strong predictor of mortality in patients with end-stage renal disease, few studies are available before the start of dialysis treatment. The purpose of this study is to evaluate the prevalence and clinical correlates of LVH in nondiabetic patients with chronic kidney disease (CKD) not yet undergoing renal replacement therapy. METHODS: We investigated 244 nondiabetic patients with CKD; 57 patients (42 men; age, 20 to 78 years) had stages 1 to 2 CKD and 187 patients (122 men; age, 18 to 77 years) had stages 3 to 5 CKD. Fifty-two normotensive healthy subjects served as controls. Each patient had blood pressure (BP) measured by means of 24-hour ambulatory BP monitoring and left ventricular mass index (LVMi) assessed by means of M-mode echocardiography. Creatinine clearance was estimated by means of the Cockcroft-Gault formula, and hemoglobin, serum lipid, and intact parathyroid hormone concentrations and daily urinary protein excretion were assessed by using routine methods. RESULTS: In the overall group, prevalences of arterial hypertension and LVH were 66% and 74%, respectively. LVMi was 160 +/- 50 g/m2 body surface area and associated directly with age (P = 0.0013), duration of arterial hypertension (P = 0.0075), 24-hour systolic BP (P = 0.0113), pulse pressure (P = 0.0003), daytime (P = 0.0206) and nighttime systolic BP (P = 0.0059), and urinary protein excretion (P < 0.05) and inversely with creatinine clearance (P = 0.0103) and hemoglobin level (P = 0.0276). In patients with CKD stages 1 to 2 (LVH prevalence, 51%), age, duration of arterial hypertension, pulse pressure, and urinary protein excretion were significant predictors of LVMi (P < 0.00002) by using stepwise regression analysis, whereas in those with CKD stages 3 to 5 (LVH prevalence, 78%), pulse pressure emerged as the sole predictor of LVMi (P = 0.0011). CONCLUSION: The prevalence of LVH in nondiabetic predialysis patients with CKD is greater than previously reported, and there is evidence that LVH already is present in the early stages of renal disease. Arterial hypertension is associated with LVH in patients with CKD, and the strong relationship between elevated pulse pressure and LVH in those with more advanced CKD suggests that increased arterial stiffness might have a role for LVH well before the start of dialysis therapy.
Authors: Christian Faul; Ansel P Amaral; Behzad Oskouei; Ming-Chang Hu; Alexis Sloan; Tamara Isakova; Orlando M Gutiérrez; Robier Aguillon-Prada; Joy Lincoln; Joshua M Hare; Peter Mundel; Azorides Morales; Julia Scialla; Michael Fischer; Elsayed Z Soliman; Jing Chen; Alan S Go; Sylvia E Rosas; Lisa Nessel; Raymond R Townsend; Harold I Feldman; Martin St John Sutton; Akinlolu Ojo; Crystal Gadegbeku; Giovana Seno Di Marco; Stefan Reuter; Dominik Kentrup; Klaus Tiemann; Marcus Brand; Joseph A Hill; Orson W Moe; Makoto Kuro-O; John W Kusek; Martin G Keane; Myles Wolf Journal: J Clin Invest Date: 2011-10-10 Impact factor: 14.808
Authors: Faraz S Ahmad; Xuan Cai; Katherine Kunkel; Ana C Ricardo; James P Lash; Dominic S Raj; Jiang He; Amanda H Anderson; Matthew J Budoff; Julie A Wright Nunes; Jason Roy; Jackson T Wright; Alan S Go; Martin G St John Sutton; John W Kusek; Tamara Isakova; Myles Wolf; Martin G Keane Journal: Am J Hypertens Date: 2017-08-01 Impact factor: 2.689
Authors: Nisha Bansal; Adam Szpiro; Frederick Masoudi; Robert T Greenlee; David H Smith; David J Magid; Jerry H Gurwitz; Kristi Reynolds; Grace H Tabada; Sue Hee Sung; Ashveena Dighe; Andrea Cassidy-Bushrow; Romel Garcia-Montilla; Stephen Hammill; John Hayes; Alan Kadish; Param Sharma; Paul Varosy; Humberto Vidaillet; Alan S Go Journal: Heart Date: 2016-10-14 Impact factor: 5.994
Authors: Mohammed Alghamdi; Astrid M De Souza; Colin T White; M Terri Potts; Bradley A Warady; Susan L Furth; Thomas R Kimball; James E Potts; George G S Sandor Journal: Pediatr Cardiol Date: 2013-02-05 Impact factor: 1.655