Long-Term Evolution and Changing Associations of Left Ventricular Hypertrophy after Starting Hemodialysis

Abstract

Background/Aims:Left ventricular hypertrophy (LVH) is prevalent in dialysis patients and is recognized as a potent risk factor for cardiovascular diseases. We examined the evolution of LVH after starting dialysis and the determinants of changes in LV mass. Methods: A cohort of 107 patients who had two or more echocardiograms at yearly intervals after starting hemodialysis was studied. Results: At baseline, the mean LV mass index (LVMI) was 145.8 g/m² and 73 (68%) patients had LVH. During the mean follow-up period of 34.5 months, LVMI decreased by 3.9 g/m². At last follow-up, the mean LVMI was 141.5 g/m² and 68 (64%) patients had LVH. For changes in LVMI, a significant correlation was found in changes in systolic blood pressure, LVMI at baseline, changes in serum albumin concentration, and age. The relationship between changes in LVMI and systolic blood pressure was close during the 1st and 2nd intervals, but became weak gradually during the 3rd and 4th intervals. Conclusion: Many patients had LVH at starting hemodialysis and continued to have LVH thereafter. The most important determinants of LV mass changes were baseline LV mass and systolic blood pressure control, but the grade of reduction decreased gradually with time. These results suggest that active antihypertensive treatment should be started early to regress LVH and prevent cardiovascular diseases.