Nephrology Dialysis Transplantation, Vol 13, Issue 6 1489-1493, Copyright © 1998 by Oxford University Press
M Ozkaya, E Ok, M Cirit, S Aydin, F Akcicek, A Basci and E Mees
Background: Left ventricular hypertrophy (LVH) is very
frequent in haemodialysis patients. Only few investigations have reported
its regression, and only by the use of antihypertensive drugs. Because
volume load is at least as important as pressure load, we investigated
whether persistent strict volume control by ultrafiltration alone may be
effective in improving LVH. Methods: Using blood
pressure (BP) and cardiac dimensions as a guide, we treated all
hypertensive patients in our dialysis unit during the 3 times weekly
dialysis sessions for 4 h per session with as much ultrafiltration as they
could stand. If they gained too much weight an extra isolated
ultrafiltration (UF) session was applied. Special attention was given to
dietary salt restriction. The study group of all 15 patients in whom
echocardiographic assessment had been made at least 1.5 years previously
was selected retrospectively, and we acknowledge that important confounding
factors might not have been controlled for. Cardiothoracic index (CTI) was
estimated on the chest X-ray. Diameters of left atrium (LA), left ventricle
systolic (LVS) and diastolic (LVD), interventricular septum (IVS),
posterior wall (PW), and left ventricular mass index (LVMI) were estimated
by standard echocardiographic methods. Results: Mean
arterial pressure of the study group had been lowered by UF before the
first echocardiogram from predialysis 136±11 to
101±14 and from post dialysis 119±8 to
92±12 mmHg. During a mean follow-up period of 37±11
months LVMI decreased from 175±60 to 105±11
g/m2. CTI decreased further from 48±3 to
43±4%, while significant decreases of LA (22.5±3 to
19.9±4 mm/m2), LVS (18.7±4 to
15.9±3 mm/m2) and LVD (28.3±4
to 24.0±3 mm/m2) were seen in all
patients. There also was a further decrease in both pre- and postdialysis
BP to 116±12/73±7 and
105±7/65±3 mmHg respectively.
Conclusion: The results of this uncontrolled
retrospective study suggest that good long-term BP control and a decrease
of LVM can be achieved by continuous efforts to control hypervolaemia. The
decrease in volume may be even more important than pressure reduction to
achieve this goal. Key words: echocardiography;
haemodialysis; hypertension; left ventricular hypertrophy; ultrafiltration
ORIGINAL ARTICLES
Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs
Divisions of Nephrology and Cardiology, Ege Universitesi Tip Fakultesi, Ic Hastalikari Anabilimdah, Nefroloji Bilimdah, Bornova-35100, Izmir, Turkiye; Corresponding author
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