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Echocardiographic changes following hemodialysis initiation in patients with advanced chronic kidney disease and symptomatic heart failure with reduced ejection fraction.

Abstract

BACKGROUND
In patients without overt cardiac disease, the degree of left ventricular hypertrophy (LVH) gets worse following hemodialysis (HD) initiation; however, in patients with both advanced chronic kidney disease (CKD) and symptomatic heart failure (HF) with reduced ejection fraction (EF), the short-term effect of HD on LVH and LV geometry has not been examined. We hypothesized that left ventricular mass index (LVMI) would decrease following HD initiation in CKD patients with symptomatic HF.
METHODS
We retrospectively evaluated changes in LVMI, LV geometry, and LV fractional shortening (LVFS), assessed by 2D transthoracic echocardiography (TTE), in 41 patients with HF initiating HD while hospitalized from 1995 to 2006. HF was defined by LVEF ≤ 45% or dyspnea plus two of the following: raised jugular venous pressure, bibasilar crackles, pulmonary venous hypertension, interstitial edema on chest X-ray, or both. TTE was performed within 3 months prior to first HD and repeated 8.6 ± 5.2 months after start of HD. TTE recordings were obtained from storage and analyzed by a cardiologist blinded to patient clinical characteristics.
RESULTS
Before initiation of HD, LVMI in 39 patients was 167.9 ± 53.1 g/m2 and it decreased by -24.3 ± 35.4 g/m2 by follow-up, p < 0.001. 26% of patients with concentric LVH at baseline had concentric remodeling or eccentric LVH at follow-up. LVFS did not significantly change over time in all 41 patients with HF (25.7 ± 8.7% vs. 26.4 ± 8.7%, p = 0.66). However, in an expanded analysis of all 69 patients with serial TTEs, a 1% increase in LVFS after starting HD was associated with a 16% reduction in risk of cardiovascular hospitalization at follow-up (HR 0.84, 95% CI 0.73 - 0.96, p = 0.01).
CONCLUSIONS
LVMI decreases following HD initiation in CKD patients with symptomatic HF and reduced LVEF, possibly due to relief of venous congestion. Increase in LVFS following HD initiation predicts improved cardiac outcome.

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  • Publisher Full Text
  • Authors

    Ganda A, Weiner SD, Chudasama NL, Valeri AM, Jadoon A, Shimbo D, Radhakrishnan J

    Institution

    Division of Nephrology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. ag355@columbia.edu

    Source

    Clinical nephrology 77:5 2012 May pg 366-75

    MeSH

    Aged
    Chronic Disease
    Echocardiography
    Female
    Heart Failure
    Humans
    Hypertrophy, Left Ventricular
    Kaplan-Meier Estimate
    Kidney Diseases
    Linear Models
    Logistic Models
    Male
    Middle Aged
    Multivariate Analysis
    New York City
    Predictive Value of Tests
    Proportional Hazards Models
    Recovery of Function
    Renal Dialysis
    Retrospective Studies
    Stroke Volume
    Time Factors
    Treatment Outcome
    Ventricular Dysfunction, Left
    Ventricular Function, Left
    Ventricular Remodeling

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22551882