Prevalence and Risk Factors of Myocardial Remodeling in Hemodialysis Patients

Abstract

Background. Left ventricular hypertrophy (LVH) is an independent risk factor for morbidity/mortality in patients with end stage renal disease (ESRD). Our study aimed to identify prevalence as well as independent risk factors that contribute to the development of LV geometric remodeling in our HD patients. Methods. The left ventricles of 116 HD patients were classified echocardiographically into four different geometric patterns on the basis of LV mass and relative wall thickness. Furthermore, we measured inferior vena cava (IVC) diameter and its collapsibility index (CI) by echocardiography. Finally, we modeled a stepwise multiple regression analysis to determine the predictors of LV geometry. Results. Our study provides evidence that HD patients had a prevalence of abnormal LV geometry in 92% and LVH in 81%. We found all four geometric models of LV. Most dominant were eccentric LVH. Concentric LVH was observed in 37, normal geometry (NG) in 9, and concentric remodeling (CR) in 13 of HD patients. Mean arterial blood pressure was significantly higher in the cLVH group (95 ± 10 mmHg) than in the NG and CR groups (81.6 ± 12.3 and 80 ± 11.8, respectively, p < 0.001). The cLVH and eCLVH groups had significantly lower mean hemoglobin (10.3 ± 1.4g/dL and 10.6 ± 1g/dL, respectively) compared with the NG group (11.9 ± 1.4g/dL), p < 0.001. Furthermore, interdialytic weight gain (kg) was significantly higher in eCLVH group (3.13 ± 0.8) than in NG group (2.3 ± 1.1), p < 0.001. Mean IVC index of the eLVH group (10.83 ± 2.07 mm/m2) was significantly higher than corresponding indexes of NG (10.83 ± 2.07 mm/m2), CR (8.31 ± 1.32 mm/m2) and cLVH (8.12 ± 2.06 mm/m2) groups (p < 0.001 for each comparisons). Conclusion. Mean arterial pressure, hemoglobin, IVC index, and interdialytic weight gain were found to be independent predictors of LV geometry (R2 = 0.147; p < 0.001) in HD patients.