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| Left ventricular mass index increase in early renal disease: Impact of decline in hemoglobin |
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| Author(s): Levin A, Thompson CR, Ethier J, Carlisle EJF, Tobe S, Mendelssohn D, Burgess E, Jindal K, Barrett B, Singer J, Djurdjev O |
| Source: AMERICAN JOURNAL OF KIDNEY DISEASES Volume: 34 Issue: 1 Pages: 125-134 Published: JUL 1999 |
| Times Cited: 374 References: 38 |
| Abstract: Cardiovascular disease occurs in patients with progressive renal disease both before and after the initiation of dialysis. Left ventricular hypertrophy (LVH) is an independent predictor of morbidity and mortality in dialysis populations and is common in the renal insufficiency population. LVH is associated with numerous modifiable risk factors, but little is known about LV growth (LVG) in mild-to-moderate renal insufficiency. This prospective multicenter Canadian cohort study identifies factors associated with LVG, measured using two-dimensional-targeted M-mode echocardiography. Eight centers enrolled 446 patients, 318 of whom had protocol-mandated clinical, laboratory, and echocardiographic measurements recorded. We report 246 patients with assessable echocardiograms at both baseline and 12 months with an overall prevalence of LVH of 36%. LV mass index (LVMI) increased significantly (>20% of baseline or >20 g/m(2)) from baseline to 12 months in 25% of the population. Other than baseline LVMI, no differences in baseline variables were noted between patients with and without LVG. However, there were significant differences in decline of Hgb level (-0.854 v -0.108 g/dL; P = 0.0001) and change in systolic blood pressure (+6.50 v -1.09 mm Hg; P = 0.03) between the groups with and without LVG. Multivariate analysis showed the independent contribution of decrease in Hgb level (odds ratio [OR], 1.32 for each 0.5-g/dL decrease; P = 0.004), increase in systolic blood pressure (OR, 1.11 for each 5-mm Hg increase; P = 0.01), and lower baseline LVMI (OR, 0.85 for each 10-g/m(2); P = 0.011) in predicting LVG. Thus, after adjusting for baseline LVMI, Hgb level and systolic blood pressure remain independently important predictors of LVG. We defined the important modifiable risk factors. There remains a critical need to establish optimal therapeutic strategies and targets to improve clinical outcomes. (C) 1999 by the National Kidney Foundation, Inc. |
| Document Type: Article |
| Language: English |
| Reprint Address: Levin, A (reprint author), St Pauls Hosp, Renal Insufficiency Clin, Room 6010 A,Providence Wing,1081 Burrard St, Vancouver, BC V6Z 1Y8 Canada |
Addresses:
1. St Pauls Hosp, Renal Insufficiency Clin, Vancouver, BC V6Z 1Y8 Canada
2. Ctr Hlth Outcomes & Evaluat Sci, Vancouver, BC Canada
3. Hotel Dieu, Montreal, PQ Canada
4. St Josephs Hosp, Hamilton, ON Canada
5. Toronto Hosp, Toronto, ON M5T 2S8 Canada
6. Foothills Hosp, Calgary, AB T2N 2T9 Canada
7. Victoria Gen Hosp, Halifax, NS B3H 2Y9 Canada
8. Mem Univ Newfoundland, St Johns, NF Canada
9. Sunnybrook Hosp, Toronto, ON Canada |
| Publisher: W B SAUNDERS CO, INDEPENDENCE SQUARE WEST CURTIS CENTER, STE 300, PHILADELPHIA, PA 19106-3399 USA |
| Subject Category: Urology & Nephrology |
| IDS Number: 213HT |
| ISSN: 0272-6386 |
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