Impact of dialysis modality on left ventricular geometry assessed by echocardiography in patients with end stage renal disease

Abstract

Purpose: Left ventricular hypertrophy (LVH) is an independent risk factor for morbidity and mortality in patients with end stage renal disease. This study aimed to evaluate pattern of LV remodeling according to dialysis modality in patients with end stage renal disease. Methods: We retrospectively evaluated change in LV mass index (LVMI), relative wall thickness (RWT) and LV geometry, assessed by 2D transthoracic echocardiography, in patients starting dialysis while hospitalized from 2000 to 2012. Patients were classified into hemodialysis (HD) group and peritoneal dialysis (PD) group. Follow-up duration of performing echocardiogram was 11.6±4.5 months. LV geometry was divided into 4 groups as normal LV geometry, concentric remodeling, concentric LVH and eccentric LVH according to LVMI and RWT using cutoff values of 131 (men) or 100 (women) g/m2 for LVMI and 0.45 for RWT, both men and women. The multivariate analysis was performed to evaluate the independent predictors of change in LV geometry among the patients who showed the change of LV geometry. Results: 74 patients with HD (age 54.9±13.0 years, 50.0% male) and 34 patients with PD (age 48±15.1 years, 58.8% male) were enrolled. Before initiation of dialysis, there were no significant difference of ejection fraction, LVMI, RWT (56.1±14.0% vs. 55.8±14.2%, p=0.898; 169.0±47.9g/m2 vs. 168.5±57.3g/m2, p=0.964; 0.46±0.1 vs. 0.46±0.1, p=0.937, respectively). There was no difference of geometry distribution between two groups (4.1% vs. 5.9% concentric remodeling, 51.4% vs. 50.0% concentric LVH, 37.8% vs. 32.4% eccentric LVH, respectively). Follow-up echocardiogram revealed that LVMI and RWT in both groups were not significantly different (166.4±44.4g/m2 vs. 154.5±49.0g/m2, p=0.221; 0.47±0.10 vs. 0.48±0.12, p=0.287). LVMI and RWT showed no significant difference over time in both groups (p=0.63 vs. p=0.22; p=0.31 vs. 0.93, respectively). However, the geometric change of LV was significantly different between two groups. Change to eccentric LVH from the other LV geometries was significantly higher in PD group (37.8% vs. 87.5%, p=0.001, Odds ratio [OR] 11.5, 95% Confidence interval [CI] 2.3-58.3). Change to concentric LVH from the other geometries was not significantly different. PD was associated with increase of LVMI (OR 2.88 95% CI 0.86-9.96). HD was associated with reduction of LVMI (OR 1.89 95% CI 0.94-3.97). Conclusion: Otherwise there was no difference in prevalence of LV geometry pattern at the time of initiating dialysis, PD was an independent predictor for LVMI increment and HD was an independent predictor for LVMI reduction.