Abstract 2933: Left Ventricular Structure And Functions In Hemodialysis Patients Treated By Strict Volume Control
Left ventricular hypertrophy (LVH) is reported to be as high as 70 – 80% in hemodialysis (HD) patients from the centers, where blood pressure can be controlled only in 50% of cases despite use of antihypertensive medications up to 90% of the patients. We evaluated LV structure and functions by echocardiography in HD patients treated by strict volume control strategy with rare usage (<10%) of antihypertensive medications, in order to clarify whether volume control could prevent progression of cardiac abnormalities in HD.
METHODS: All 704 patients, who were on our HD centre for at least 6 months, underwent echocardiography on a nondialysis day. Cardiac dimensions were measured and type of LVH was described according to relative wall thickness (RWT). Systolic function was judged by ejection fraction (EF); diastolic function was assessed from both mitral inflow PW Doppler and Tissue Doppler imaging (TDI).
RESULTS: Echocardiographic images were available for evaluation in 621 patients. Mean HD duration was 55±46 months, interdialytic weight gain 2.31±0.94 kg, systolic blood pressure (SBP) 125±16 mmHg, diastolic blood pressure (DBP) 75±9 mmHg. Only 7% of patients were receiving antihypertensive agents. LVH (LVMI ≥ 150gr/m in men, ≥120 g/m in women) was present in 42% of patients. LVH was of the concentric type (RWT≥45) in almost all cases (96%). The LVMI was correlated with age (r: 0.15, p: 0.001), diabetes (r:0.097, p:0.001), SBP (r:0.23, p:0.001), DBP (r:0.17, p:0.01), and interdialytic weight gain (r: 0.14, p:0.001). No correlation was found between LVMI and duration of HD. Mean EF was 66±10%. Systolic dysfunction (EF <45%) was present in only 9%. Diastolic dysfunction (by TDI) was observed in 62% of the patients.
CONCLUSION: This is the largest echocardiographic study on HD patients. In patients under volume control strategy for hypertension, LVH was present in 42% and of the concentric type. No correlation is seen between LVH and duration of dialysis. These data suggest that development and progression of left ventricular abnormalities are not inevitable when strict volume control policy is applied.