Nephrol Dial Transplant (1996) 11: 1277-1285
© 1996 European Renal Association-European Dialysis and Transplant Association
research-article
Outcome and risk factors for left ventricular disorders in chronic uraemia
Division of Nephrology, Health Sciences Centre, Memorial University; Division of Nephrology, Salvation Army Grace General Hospital, St John's, Newfoundland (DCM); Division of Nephrology, Royal Victoria Hospital, McGill University Montreal, Quebec (PEB), Canada
Correspondence and offprint requests to: Correspondence and offprint requests to: Dr Patrick S. Parfrey, Memorial University of Newfoundland, The Health Sciences Centre, St John's, Newfoundland, Canada A1B 3V6
BACKGROUND: Left ventricular disease occurs frequently in dialysis patients. It may be manifest as concentric LV hypertrophy, LV dilatation with or without LV hypertrophy, or systolic dysfunction. Little is known concerning the clinical outcome and risk factors for these disorders.
METHODS: A cohort of 432 end-stage renal disease patients who survived at least 6 months had an echo-cardiogram on initiation of dialysis therapy. Clinical, laboratory and echocardiographic data was obtained annually during follow-up.
RESULTS: On initiation of ESRD therapy 16% of patients had systolic dysfunction, 41% concentric LV hypertrophy, 28% LV dilatation, and only 16% had normal echocardiograms. Median time to development of heart failure was 19 months in patients with systolic dysfunction, 38 months in concentric LV hypertrophy and 38 months in LV dilatation. The relative risks of heart failure in the three groups were significantly worse than in the normal group, after adjusting for age, diabetes and ischaemic heart disease. Median survival was 38 months in systolic dysfunction, 48 months in concentric hypertrophy, 56 months in LV dilatation, and >66 months in the normal group.
Two hundred and seventy-five patients had a follow-up echocardiogram 17 months after starting dialysis therapy together with serial measurement of potential risk factors prior to the echocardiogram. On follow-up echocardiogram the degree of concentric LV hypertrophy was independently related to hypertension while on dialysis, older age, and anaemia while on dialysis; the degree of LV dilatation was related to ischaemic heart disease, anaemia, hypertension and hypoalbuminemia while on dialysis; the degree of systolic dysfunction was associated with ischaemic heart disease and anaemia during follow-up.
CONCLUSIONS: Manifestations of left ventricular disease are frequent and persistent in chronic uraemia, and are associated with high risks of heart failure and death. Potentially reversible risk factors include anaemia, hypertension, hypoalbuminaemia and ischaemic heart disease.
Keywords: left ventricular disease; chronic uraemia; heart failure; anaemia; hypertension; hypoalbuminaemia; ischaemic heart disease
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. M. Sood, R. P. Pauly, C. Rigatto, and P. Komenda Left ventricular dysfunction in the haemodialysis population NDT Plus, August 1, 2008; 1(4): 199 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Schietinger, G. M. Brammer, H. Wang, J. M. Christopher, K. W. Kwon, A. J. Mangrum, J. M. Mangrum, and C. M. Kramer Patterns of Late Gadolinium Enhancement in Chronic Hemodialysis Patients J. Am. Coll. Cardiol. Img., July 1, 2008; 1(4): 450 - 456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Y. Hayashi, A. Seeberger, B. Lind, J. Nowak, M. M. do Nascimento, B. Lindholm, and L.-A. Brodin A single session of haemodialysis improves left ventricular synchronicity in patients with end-stage renal disease: a pilot tissue synchronization imaging study Nephrol. Dial. Transplant., June 13, 2008; (2008) gfn311v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. A. K. M. Windt, R. H. Henning, A. C. A. Kluppel, Y. Xu, D. de Zeeuw, and R. P. E. van Dokkum Myocardial infarction does not further impair renal damage in 5/6 nephrectomized rats Nephrol. Dial. Transplant., June 4, 2008; (2008) gfn233v2. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ritz and C. Wanner The Challenge of Sudden Death in Dialysis Patients Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 920 - 929. [Full Text] [PDF]
|
|
|
|
 |
|
 C. M Clase Statins for people with kidney disease BMJ, March 22, 2008; 336(7645): 624 - 625. [Full Text] [PDF]
|
|
|
|
|
|
D. Banerjee, J. Z. Ma, A. J. Collins, and C. A. Herzog Long-Term Survival of Incident Hemodialysis Patients Who Are Hospitalized for Congestive Heart Failure, Pulmonary Edema, or Fluid Overload Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1186 - 1190. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Bodyak, J. C. Ayus, S. Achinger, V. Shivalingappa, Q. Ke, Y.-S. Chen, D. L. Rigor, I. Stillman, H. Tamez, P. E. Kroeger, et al. Activated vitamin D attenuates left ventricular abnormalities induced by dietary sodium in Dahl salt-sensitive animals PNAS, October 23, 2007; 104(43): 16810 - 16815. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Mark, R. K. Patel, and A. G. Jardine Are we overestimating left ventricular abnormalities in end-stage renal disease? Nephrol. Dial. Transplant., July 1, 2007; 22(7): 1815 - 1819. [Full Text] [PDF]
|
|
|
|
|
|
J. Nogueira and M. Weir The Unique Character of Cardiovascular Disease in Chronic Kidney Disease and Its Implications for Treatment with Lipid-Lowering Drugs Clin. J. Am. Soc. Nephrol., July 1, 2007; 2(4): 766 - 785. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Postorino, C. Marino, G. Tripepi, C. Zoccali, and on behalf of the Calabrian Registry of Dialysis an Prognostic value of the New York Heart Association classification in end-stage renal disease Nephrol. Dial. Transplant., May 1, 2007; 22(5): 1377 - 1382. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Moriya, T. Ohtake, and S. Kobayashi Aortic stiffness, left ventricular hypertrophy and weekly averaged blood pressure (WAB) in patients on haemodialysis Nephrol. Dial. Transplant., April 1, 2007; 22(4): 1198 - 1204. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Sharma, E. Chemla, M. Tome, R. L Mehta, H. Gregson, S. J D Brecker, R. Chang, and D. Pellerin Echocardiography-based score to predict outcome after renal transplantation Heart, April 1, 2007; 93(4): 464 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Reddy, S. Bhandari, and A.-M. L. Seymour Myocardial Function, Energy Provision, and Carnitine Deficiency in Experimental Uremia J. Am. Soc. Nephrol., January 1, 2007; 18(1): 84 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Briese, S. Wiesner, J. C. Will, A. Lembcke, B. Opgen-Rhein, R. Nissel, K.-D. Wernecke, J. Andreae, D. Haffner, and U. Querfeld Arterial and cardiac disease in young adults with childhood-onset end-stage renal disease--impact of calcium and vitamin D therapy Nephrol. Dial. Transplant., July 1, 2006; 21(7): 1906 - 1914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Himmelfarb Dialysis at a Crossroads: Reverse Engineering Renal Replacement Therapy Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 896 - 902. [Full Text] [PDF]
|
|
|
|
|
|
C. Zoccali, F. A. Benedetto, G. Tripepi, F. Mallamaci, F. Rapisarda, G. Seminara, G. Bonanno, and L. S. Malatino Left Ventricular Systolic Function Monitoring in Asymptomatic Dialysis Patients: A Prospective Cohort Study J. Am. Soc. Nephrol., May 1, 2006; 17(5): 1460 - 1465. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Levin, O. Djurdjev, J. Duncan, D. Rosenbaum, and R. Werb Haemoglobin at time of referral prior to dialysis predicts survival: an association of haemoglobin with long-term outcomes Nephrol. Dial. Transplant., February 1, 2006; 21(2): 370 - 377. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Bionda, C. Bergerot, D. Ardail, C. Rodriguez-Lafrasse, and R. Rousson Plasma BNP and NT-proBNP Assays by Automated Immunoanalyzers: Analytical and Clinical Study Ann. Clin. Lab. Sci., January 1, 2006; 36(3): 299 - 306. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P Van der Meer, E Lipsic, R. Henning, K Boddeus, J van der Velden, A. Voors, D. van Veldhuisen, W. van Gilst, R. Schoemaker, J. Leemans, et al. Heart Failure after Myocardial Infarction--Benefit beyond Hemoglobin from Erythropoietin: Erythropoietin Induces Neovascularization and Improves Cardiac Function in Rats with Heart Failure after Myocardial Infarction J. Am. Soc. Nephrol., December 1, 2005; 16(12): 3449 - 3454. [Full Text] [PDF]
|
|
|
|
 |
|
 G. Knoll, S. Cockfield, T. Blydt-Hansen, D. Baran, B. Kiberd, D. Landsberg, D. Rush, E. Cole, and for The Kidney Transplant Working Group of the Can Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation Can. Med. Assoc. J., November 8, 2005; 173(10): S1 - S25. [Full Text] [PDF]
|
|
|
|
|
|
H. CY, M. CE, D. J, G. AS, I. C, T. E, C. HC, L. M, R. S, R. ER, et al. Which Comes First--Renal Dysfunction or High Blood Pressure?: Elevated Blood Pressure and Risk of End-Stage Renal Disease in Subjects without Baseline Kidney Disease. Arch Intern Med 165: 923-928, 2005 J. Am. Soc. Nephrol., October 1, 2005; 16(10): 2817 - 2820. [Full Text] [PDF]
|
|
|
|
|
|
P. S. Parfrey, R. N. Foley, B. H. Wittreich, D. J. Sullivan, M. J. Zagari, D. Frei, and for the Canadian European Study Double-Blind Comparison of Full and Partial Anemia Correction in Incident Hemodialysis Patients without Symptomatic Heart Disease J. Am. Soc. Nephrol., July 1, 2005; 16(7): 2180 - 2189. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. G. Wahl, S. Graf, H. Renz, and W. Fassbinder Elimination of the Cardiac Natriuretic Peptides B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP by Hemodialysis Clin. Chem., June 1, 2004; 50(6): 1071 - 1074. [Full Text] [PDF]
|
|
|
|
|
|
L. P. McMahon, S. D. Roger, and A. Levin Development, Prevention, and Potential Reversal of Left Ventricular Hypertrophy in Chronic Kidney Disease J. Am. Soc. Nephrol., June 1, 2004; 15(6): 1640 - 1647. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Zoccali, F. A. Benedetto, F. Mallamaci, G. Tripepi, G. Giacone, A. Cataliotti, G. Seminara, B. Stancanelli, and L. S. Malatino Prognostic Value of Echocardiographic Indicators of Left Ventricular Systolic Function in Asymptomatic Dialysis Patients J. Am. Soc. Nephrol., April 1, 2004; 15(4): 1029 - 1037. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Conti, I. M. Renaud, B. Poirier, O. Michel, M.-F. Belair, C. Mandet, P. Bruneval, I. Myara, and J. Chevalier High levels of myocardial antioxidant defense in aging nondiabetic normotensive Zucker obese rats Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2004; 286(4): R793 - R800. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. W. Doulton and G. A MacGregor Review: Blood pressure in haemodialysis patients: The importance of the relationship between the renin-angiotensin-aldosterone system, salt intake and extracellular volume Journal of Renin-Angiotensin-Aldosterone System, March 1, 2004; 5(1): 14 - 22. [Abstract] [PDF]
|
|
|
|
 |
|
 P. van der Meer, A. A. Voors, E. Lipsic, W. H. van Gilst, and D. J. van Veldhuisen Erythropoietin in cardiovascular diseases Eur. Heart J., February 2, 2004; 25(4): 285 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. F. Griffith, D. N. Reddan, P. S. Klassen, and W. F. Owen Left ventricular hypertrophy: a surrogate end point or correlate of cardiovascular events in kidney disease? Nephrol. Dial. Transplant., December 1, 2003; 18(12): 2479 - 2482. [Full Text] [PDF]
|
|
|
|
|
|
A. Toprak, M. Koc, H. Tezcan, I. C. Ozener, E. Akoglu, and A. Oktay Inferior vena cava diameter determines left ventricular geometry in continuous ambulatory peritoneal dialysis patients: an echocardiographic study Nephrol. Dial. Transplant., October 1, 2003; 18(10): 2128 - 2133. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A.M. Sharma Renal involvement in hypertensive cardiovascular disease Eur. Heart J. Suppl., August 1, 2003; 5(suppl_F): F12 - F18. [Abstract] [PDF]
|
|
|
|
|
|
K. Amann, C. Ritz, M. Adamczak, and E. Ritz Why is coronary heart disease of uraemic patients so frequent and so devastating? Nephrol. Dial. Transplant., April 1, 2003; 18(4): 631 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Furuland, T. Linde, J. Ahlmen, A. Christensson, U. Strombom, and B. G. Danielson A randomized controlled trial of haemoglobin normalization with epoetin alfa in pre-dialysis and dialysis patients Nephrol. Dial. Transplant., February 1, 2003; 18(2): 353 - 361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A Sica and T. W. Gehr Review: The pharmacokinetics and pharmacodynamics of angiotensin-receptor blockers in end-stage renal disease Journal of Renin-Angiotensin-Aldosterone System, December 1, 2002; 3(4): 247 - 254. [Abstract] [PDF]
|
|
|
|
|
|
A. Levin The role of anaemia in the genesis of cardiac abnormalities in patients with chronic kidney disease Nephrol. Dial. Transplant., February 1, 2002; 17(2): 207 - 210. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Meaume, A. Benetos, O.F. Henry, A. Rudnichi, and M.E. Safar Aortic Pulse Wave Velocity Predicts Cardiovascular Mortality in Subjects >70 Years of Age Arterioscler. Thromb. Vasc. Biol., December 1, 2001; 21(12): 2046 - 2050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. London, B. Pannier, A. P. Guerin, J. Blacher, S. J. Marchais, B. Darne, F. Metivier, H. Adda, and M. E. Safar Alterations of Left Ventricular Hypertrophy in and Survival of Patients Receiving Hemodialysis: Follow-up of an Interventional Study J. Am. Soc. Nephrol., December 1, 2001; 12(12): 2759 - 2767. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. LOCATELLI, D. MARCELLI, F. CONTE, M. D'AMICO, L. D. VECCHIO, A. LIMIDO, F. MALBERTI, and D. SPOTTI Survival and Development of Cardiovascular Disease by Modality of Treatment in Patients with End-Stage Renal Disease J. Am. Soc. Nephrol., November 1, 2001; 12(11): 2411 - 2417. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. G Jardine and K. McLaughlin GENERAL CARDIOLOGY: Cardiovascular complications of renal disease Heart, October 1, 2001; 86(4): 459 - 466. [Full Text] [PDF]
|
|
|
|
|
|
C. ZOCCALI, F. MALLAMACI, F. A. BENEDETTO, G. TRIPEPI, S. PARLONGO, A. CATALIOTTI, S. CUTRUPI, G. GIACONE, I. BELLANUOVA, E. COTTINI, et al. Cardiac Natriuretic Peptides Are Related to Left Ventricular Mass and Function and Predict Mortality in Dialysis Patients J. Am. Soc. Nephrol., July 1, 2001; 12(7): 1508 - 1515. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. O'Riordan and R. N. Foley When should we start erythropoietin therapy? Nephrol. Dial. Transplant., May 1, 2001; 16(5): 891 - 892. [Full Text] [PDF]
|
|
|
|
|
|
R. J. MIDDLETON, P. S. PARFREY, and R. N. FOLEY Left Ventricular Hypertrophy in the Renal Patient J. Am. Soc. Nephrol., May 1, 2001; 12(5): 1079 - 1084. [Full Text]
|
|
|
|
|
|
J. J. G. De Lima, M. L. C. Vieira, H. Abensur, and E. M. Krieger Baseline blood pressure and other variables influencing survival on haemodialysis of patients without overt cardiovascular disease Nephrol. Dial. Transplant., April 1, 2001; 16(4): 793 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Locatelli, J. Bommer, G. M. London, A. Martin-Malo, C. Wanner, M. Yaqoob, and C. Zoccali Cardiovascular disease determinants in chronic renal failure: clinical approach and treatment Nephrol. Dial. Transplant., March 1, 2001; 16(3): 459 - 468. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. P. Guerin, J. Blacher, B. Pannier, S. J. Marchais, M. E. Safar, and G. M. London Impact of Aortic Stiffness Attenuation on Survival of Patients in End-Stage Renal Failure Circulation, February 20, 2001; 103(7): 987 - 992. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. C. M. van Duijnhoven, E. C. M. Cheriex, J. H. M. Tordoir, J. P. Kooman, and J. P. van Hooff Effect of closure of the arteriovenous fistula on left ventricular dimensions in renal transplant patients Nephrol. Dial. Transplant., February 1, 2001; 16(2): 368 - 372. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Zoccali Sleep apnoea and nocturnal hypoxaemia in dialysis patients: mere risk-indicators or causal factors for cardiovascular disease? Nephrol. Dial. Transplant., December 1, 2000; 15(12): 1919 - 1921. [Full Text] [PDF]
|
|
|
|
|
|
P. Stenvinkel, O. Heimburger, B. Lindholm, G. A. Kaysen, and J. Bergstrom Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation and atherosclerosis (MIA syndrome) Nephrol. Dial. Transplant., July 1, 2000; 15(7): 953 - 960. [Full Text] [PDF]
|
|
|
|
|
|
E. Mcgregor, G. Stewart, R. S. C. Rodger, and A. G. Jardine Early echocardiographic changes and survival following renal transplantation Nephrol. Dial. Transplant., January 1, 2000; 15(1): 93 - 98. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. PARFREY and R. N. FOLEY The Clinical Epidemiology of Cardiac Disease in Chronic Renal Failure J. Am. Soc. Nephrol., July 1, 1999; 10(7): 1606 - 1615. [Full Text]
|
|
|
|
|
|
J. Q. JAEGER and R. L. MEHTA Assessment of Dry Weight in Hemodialysis: An Overview J. Am. Soc. Nephrol., February 1, 1999; 10(2): 392 - 403. [Abstract] [Full Text]
|
|