A 10% decrease in left ventricular mass was associated with a reduced risk of all-cause mortality (HR 0.78; 95% CI 0.63-0.92) and cardiovascular mortality in patients receiving hemodialysis.
Cohort (n=153)
Does left ventricular mass regression improve survival in patients receiving hemodialysis?
Partial regression of left ventricular hypertrophy in hemodialysis patients is associated with improved all-cause and cardiovascular survival.
Effect estimate: HR 0.78 (95% CI 0.63-0.92)
Left ventricular (LV) hypertrophy (LVH) is a risk factor for mortality in patients with end-stage renal disease (ESRD). Whether the attenuation of LVH has a positive effect on survival of patients with ESRD has not been documented. The aim of this study was to determine the effect of parallel treatment of hypertension and anemia on LV mass (LVM) and to determine the effect of LVM changes on survival. A cohort of 153 patients receiving hemodialysis was studied. The duration of follow-up was 54 +/- 37 mo. All patients had echocardiographic determination of LV dimensions and LVM at baseline and regular intervals until the end of the follow-up period. During the study, BP decreased from (mean +/- SD) 169.4 +/- 29.7/90.2 +/- 15.6 to 146.7 +/- 29/78 +/- 14.1 mmHg (P < 0.001), and hemoglobin increased from 8.65 +/- 1.65 to 10.5 +/- 1.45 g/dl (P < 0.001). The LV end-diastolic diameter and mean wall thickness decreased from 56.6 +/- 6.5 to 54.8 +/- 6.5 mm (P < 0.001), and from 10.4 +/- 1.6 to 10.2 +/- 1.6 mm (P < 0.05), respectively. The LVM decreased from 290 +/- 80 to 264 +/- 86 g (P < 0.01). Fifty-eight deaths occurred, 38 attributed to cardiovascular (CV) disease and 20 attributed to non-CV causes. According to Cox analyses after adjustment for age, gender, diabetes, history of CV disease, and all nonspecific CV risk factors, LVM regression positively affected the survival. The hazard risk ratio associated with a 10% LVM decrease was 0.78 (95% confidence interval, 0.63 to 0.92) for all-causes mortality and 0.72 (95% confidence interval, 0.51 to 0.90) for mortality due to CV disease. These results show that a partial LVH regression in patients with ESRD had a favorable and independent effect on patients' all-cause and CV survival.
London et al. (2001) conducted a cohort in End-stage renal disease (ESRD) receiving hemodialysis (n=153). 10% decrease in left ventricular mass (LVM) was evaluated on All-causes mortality (HR 0.78, 95% CI 0.63-0.92). A 10% decrease in left ventricular mass was associated with a reduced risk of all-cause mortality (HR 0.78; 95% CI 0.63-0.92) and cardiovascular mortality in patients receiving hemodialysis.