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Left ventricular mass index increase in early renal disease: Impact of decline in hemoglobin
- Source :
- Scopus-Elsevier
-
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.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Population
Blood Pressure
Left ventricular hypertrophy
Cohort Studies
Hemoglobins
Risk Factors
Internal medicine
medicine
Prevalence
Humans
Prospective Studies
Renal Insufficiency
Risk factor
education
Dialysis
education.field_of_study
business.industry
Incidence
Anemia
Odds ratio
Middle Aged
medicine.disease
Surgery
Blood pressure
Nephrology
Echocardiography
Cardiology
Female
Hypertrophy, Left Ventricular
Hemodialysis
business
Kidney disease
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Scopus-Elsevier
- Accession number :
- edsair.doi.dedup.....a48b02ad8071fa3b9686060d21b31469