Left Ventricular Hypertrophy in Nondiabetic Predialysis CKD

doi:10.1053/j.ajkd.2005.04.031

American Journal of Kidney Diseases

Volume 46, Issue 2, August 2005, Pages 320-327

Presented in part at the American Society of Hypertension 19th Annual Meeting, New York, NY, May 18–22, 2004. Published in abstract form in Am J Hypertens 17:21A, 2004.

https://doi.org/10.1053/j.ajkd.2005.04.031 Get rights and content

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.

Section snippets

Methods

From a cohort of 315 consecutive patients referred for the first time to our Nephrology Division for CKD during a 3-year period starting January 2000, a total of 244 subjects were considered eligible for this study. All patients were classified on the basis of different stages of CKD according to the NKF-Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines.¹⁴ Fifty-seven patients with a creatinine clearance (CrCl) greater than 60 mL/min (>1.00 mL/s) and signs or symptoms of

Demographic and Clinical Data for 244 Patients With CKD

Table 1 lists pertinent demographic and clinical data for the 244 patients with CKD. In the overall group of 244 patients with CKD, prevalences of AH and LVH were 66% and 74%, respectively.

LVMi was associated directly with age (r_P = 0.22; P = 0.0013), duration of AH (r_P = 0.18; P = 0.0075), 24-hour SBP (r_P = 0.17; P = 0.0113), PP (r_P = 0.24; P = 0.0003), daytime (r_P = 0.16; P = 0.0206) and nighttime SBP (r_P = 0.18; P = 0.0059), and urinary protein excretion (r_P = 0.14; P < 0.05) and inversely

Discussion

CVD in patients with CKD is considered a public health problem because renal patients are more likely to die as a result of CVD than to reach ESRD.²⁰ The NKF Task Force on CVD in Chronic Renal Disease recommended that patients with CKD be placed in the highest risk group for subsequent CVD and identified LVH as a main target of intervention.2, 4

The prevalence of LVH in nondiabetic patients with CKD from our study is greater than that observed in the general unselected population²¹ and controls.

Acknowledgment

The authors thank Mark Northway for help in revision of the manuscript.

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: Originally published online as doi:10.1053/j.ajkd.2005.04.031 on June 22, 2005.

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Dialysis therapyLeft Ventricular Hypertrophy in Nondiabetic Predialysis CKD

Section snippets

Methods

Demographic and Clinical Data for 244 Patients With CKD

Discussion

Acknowledgment

Am J Kidney Dis

Am J Kidney Dis

Kidney Int

Am J Kidney Dis

Kidney Int

Am J Kidney Dis

Am J Kidney Dis

Kidney Int

Am J Cardiol

Am J Kidney Dis

Kidney Int

Kidney Int

J Am Coll Cardiol

Kidney disease as a risk factor for development of cardiovascular disease. A statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention

Circulation

Controlling the epidemic of cardiovascular disease in chronic renal diseaseReport from the National Kidney Foundation Task Force on Cardiovascular Disease

J Am Soc Nephrol

Outcome and risk factors for left ventricular disorders in chronic uremia

Nephrol Dial Transplant

Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysisFollow-up of an interventional study

J Am Soc Nephrol

Dialysis therapy
Left Ventricular Hypertrophy in Nondiabetic Predialysis CKD