Chronic kidney disease elicits excessive increase in left ventricular mass growth in patients at increased risk for cardiovascular events

Abstract

The hemodynamic alterations induced by the impairment of renal function explain only in part the development of left ventricular hypertrophy in patients with chronic kidney disease (CKD), who are theoretically exposed to an inappropriate high growth of left ventricular mass (iLVM) due to the activation of neuro-hormonal stressors. Few data are available on the relations between iLVM and renal function. Three hundred and forty individuals at increased risk for cardiovascular events underwent assessment of renal function by the estimation of glomerular filtration rate (eGFR) and echocardiography: 227 patients had stages 1-2 CKD (eGFR ≥60 ml/min per 1.73 m), and 113 stages 3-5 (eGFR <60 ml/min per 1.73 m). LVM was predicted in each patient from height, sex and stroke work using a validated equation. iLVM was defined as LVM more than 28% of the predicted value. Sixty-eight healthy individuals served as controls. iLVM was detected in seven controls (10%) and in 146 study patients (43%). There was an inverse relation between observed/predicted LVM ratio and eGFR (r 0.54, P < 0.001). In linear regression analysis, iLVM was related to eGFR (β 0.40), relative wall thickness (β 0.29), diabetes (β 0.14), and maximal left atrial volume (β 0.25) (all P < 0.001). Prevalence of iLVM was 10% in patients in stage-1 CKD, 31% in stage 2, 67% in stage 3, and 100% in stages 4 and 5. In patients at increased risk for cardiovascular events, iLVM is strongly related to the presence and magnitude of CKD. Further longitudinal studies are needed to evaluate the prognostic value of the coexistence of iLVM and CKD.