REVERSE CARDIAC REMODELING IN DIALYSIS: THE IMPACT ON OUTCOMES: PP.22.360

Abstract

Introduction: Left ventricular hypertrophy (LVH) is common in hemodialysis patients (HD) and predicts cardiovascular outcome. Although the reversal is potentially beneficial, such issues in dialysis patients are poorest studied. The aim of this study is to evaluate, in HD patients, the influence of LVH regression on mortality and if the improvement of the risk factors involved in LVH may induce reverse remodeling. Methods: Single center, observational and longitudinal study that included consecutive HD patients, evaluated from June 2000 to October 2006, follow-up to June 2009, whose clinical, laboratory and two consecutive echocardiograms (ECO) were available. Results: From 132 patients, 54 were excluded, 46 w/o two ECO evaluations and 9 met some exclusion criteria, leaving 77 eligible patients. The median interval between assessments was 13 mo, median and maximal follow-up after the second assessment was 28 and 89 mo respectively. Mean age was 54 ± 13.8 years, 33 women, 20 blacks and 2 Asians. LVH reduction was observed in 40 patients and in 37 there was worsening. There were 10 deaths among patients that failed to reverse LVH and 6 among those that reverted. There were 9 deaths from cardiovascular causes among non-reversed LVH and two between those that reversed. Cox regression revealed that reversal of LVH was associated with lower mortality - RR 0.35 (95% CI: 0.121 – 1.016) p = 0.048 (corrected for age and calcium-phosphorus product) and lower cardiovascular mortality - RR 0.188 (95 %: 0.041–0.874) p = 0.014. Logistic regression revealed that reversal of hypertrophy was associated with angiotensin-converting enzyme (ACE) inhibition treatment (RR: 4.51; 95% CI: 1.423–14.291, p = 0.007) and control of parathyroid hormone (RR 0.998 95% 0.997 - 0.999) p = 0.025. In conclusion, this study demonstrates that LVH regression is possible in HD patients if ACE inhibition treatment and control of hyperparathyroidism. This regression was associated with a better cardiovascular outcome driving our efforts to the task of control LVH to improve survival in such patients.