Is regression of left ventricular hypertrophy in maintenance hemodialysis patients possible?

Left ventricular hypertrophy (LVH), present in 70-80% of patients at the start of dialysis, results from chronic high blood pressure, volume overload, or both, in association with a number of metabolic and neurohumoral alterations. LVH is associated with poor outcome and was considered irreversible until the end of the 20th century. Conversely, in recent years, numerous studies have been published demonstrating that LVH may regress through various therapeutic strategies such as prevention and control of anemia, control of volume load, use of antihypertensive drugs, use of daily or nocturnal hemodialysis (HD), prevention and treatment of hyperphosphatemia, administration of vitamin D or with multifactorial interventional approaches. However, it must be emphasized that most of these studies have included a small number of patients, that many are single-arm and that few are randomized and controlled. In general, it seem that further, adequate, randomized, controlled studies are warranted to better define the optimal therapeutic approach to treat LVH in end-stage renal disease patients receiving chronic HD.