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Impact of left ventricular hypertrophy on clinical outcomes in patients with dialysis: a single-center study in Japan

  • Original Article–Cardiology
  • Published:
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Abstract

Purpose

Left ventricular hypertrophy (LVH) is a well-known risk factor for poor clinical outcomes in patients undergoing dialysis. However, little evidence supports the above notion in Japan, and the influence of subtypes of LVH on prognosis.

Methods

We investigated 367 patients undergoing dialysis who underwent routine echocardiographic examinations between April and September 2018. LVH was defined as any LV mass ≥ 115 g/m2 in men and ≥ 95 g/m2 in women obtained by echocardiography. The primary endpoint was a composite outcome including all-cause death, admission due to heart failure, and ischemic heart event or stroke. LVH was divided into subtype-groups according to eccentric hypertrophy or concentric hypertrophy, and with and without hypertension.

Results

LVH was observed in 171 (47%) patients. The primary endpoint was observed in 58 patients (16%) during the median follow-up period of 500 days. Multivariable Cox regression analyses identified four independent risk factors for the primary endpoint: age, pulse rate, serum albumin level, and LV mass index (per 10-g/m2 increase; hazard ratio: 1.12, 95% confidence interval: 1.06–1.18, P < 0.001). Kaplan–Meier analyses demonstrated that patients with LVH had a worse prognosis than those without LVH in terms of the primary endpoint (log-rank P < 0.001). The incidence of the primary outcome was not significantly different between patients with eccentric or concentric hypertrophy, and between LVH patients with and without hypertension.

Conclusion

Japanese patients with LVH undergoing dialysis had a worse prognosis than those without LVH in terms of the composite clinical endpoint.

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References

  1. Harnett JD, Foley RN, Kent GM, et al. Congestive heart failure in dialysis patients: prevalence, incidence, prognosis and risk factors. Kidney Int. 1995;47:884–90.

    Article  CAS  Google Scholar 

  2. Stack AG, Bloembergen WE. Prevalence and clinical correlates of coronary artery disease among new dialysis patients in the United States: a cross-sectional study. J Am Soc Nephrol. 2001;12:1516–23.

    Article  Google Scholar 

  3. Soubassi LP, Papadakis ED, Theodoropoulos IK, et al. Incidence and risk factors of coronary artery disease in patients on chronic hemodialysis. Int J Artif Organs. 2007;30:253–7.

    Article  CAS  Google Scholar 

  4. Urena P, Malergue MC, Goldfarb B, et al. Evolutive aortic stenosis in hemodialysis patients: analysis of risk factors. Nephrologie. 1999;20:217–25.

    CAS  PubMed  Google Scholar 

  5. Parfrey PS, Foley RN, Harnett JD, et al. Outcome and risk factors for left ventricular disorders in chronic uraemia. Nephrol Dial Transpl. 1996;11:1277–85.

    Article  CAS  Google Scholar 

  6. Payne J, Sharma S, De Leon D, et al. Association of echocardiographic abnormalities with mortality in men with non-dialysis-dependent chronic kidney disease. Nephrol Dial Transpl. 2012;27:694–700.

    Article  Google Scholar 

  7. Robinson BM, Akizawa T, Jager KJ, et al. Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices. Lancet. 2016;388:294–306.

    Article  Google Scholar 

  8. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1-39.e14.

    Article  Google Scholar 

  9. Io H, Nakata J, Inoshita H, et al. Relationship among left ventricular hypertrophy, cardiovascular events, and preferred blood pressure measurement timing in hemodialysis patients. J Clin Med. 2020;9:3512.

    Article  CAS  Google Scholar 

  10. Hayashi T, Kimura T, Yasuda K, et al. Prognostic significance of left ventricular hypertrophy observed at dialysis initiation depends on the pre-dialysis use of erythropoiesis-stimulating agents. Clin Exp Nephrol. 2013;17:294–303.

    Article  CAS  Google Scholar 

  11. Obokata M, Kurosawa K, Ishida H, et al. Incremental prognostic value of ventricular-arterial coupling over ejection fraction in patients with maintenance hemodialysis. J Am Soc Echocardiogr. 2017;30:444-53.e2.

    Article  Google Scholar 

  12. Charytan D. Is left ventricular hypertrophy a modifiable risk factor in end-stage renal disease. Curr Opin Nephrol Hypertens. 2014;23:578–85.

    Article  Google Scholar 

  13. London GM, Pannier B, Guerin AP, et al. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol. 2001;12:2759–67.

    Article  Google Scholar 

  14. Zoccali C, Benedetto FA, Mallamaci F, et al. Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression. Kidney Int. 2004;65:1492–8.

    Article  Google Scholar 

  15. Tai DJ, Lim TW, James MT, et al. Cardiovascular effects of angiotensin converting enzyme inhibition or angiotensin receptor blockade in hemodialysis: a meta-analysis. Clin J Am Soc Nephrol. 2010;5:623–30.

    Article  Google Scholar 

  16. Harnett JD, Kent GM, Barre PE, et al. Risk factors for the development of left ventricular hypertrophy in a prospectively followed cohort of dialysis patients. J Am Soc Nephrol. 1994;4:1486–90.

    Article  CAS  Google Scholar 

  17. Zoccali C, Benedetto FA, Tripepi G, et al. Cardiac consequences of hypertension in hemodialysis patients. Semin Dial. 2004;17:299–303.

    Article  Google Scholar 

  18. Edwards NC, Moody WE, Chue CD, et al. Defining the natural history of uremic cardiomyopathy in chronic kidney disease: the role of cardiovascular magnetic resonance. JACC Cardiovasc Imaging. 2014;7:703–14.

    Article  Google Scholar 

  19. Mark PB, Johnston N, Groenning BA, et al. Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging. Kidney Int. 2006;69:1839–45.

    Article  CAS  Google Scholar 

  20. Schietinger BJ, Brammer GM, Wang H, et al. Patterns of late gadolinium enhancement in chronic hemodialysis patients. JACC Cardiovasc Imaging. 2008;1:450–6.

    Article  Google Scholar 

  21. Cohn JN, Ferrari R, Sharpe N. Cardiac remodeling–concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000;35:569–82.

    Article  CAS  Google Scholar 

  22. Frohlich ED, Susic D. Pressure overload. Heart Fail Clin. 2012;8:21–32.

    Article  Google Scholar 

  23. Nitta K, Akiba T, Uchida K, et al. Left ventricular hypertrophy is associated with arterial stiffness and vascular calcification in hemodialysis patients. Hypertens Res. 2004;27:47–52.

    Article  Google Scholar 

  24. Kaesler N, Babler A, Floege J, et al. Cardiac remodeling in chronic kidney disease. Toxins (Basel). 2020;12:161.

    Article  CAS  Google Scholar 

  25. Lekawanvijit S, Adrahtas A, Kelly DJ, et al. Does indoxyl sulfate, a uraemic toxin, have direct effects on cardiac fibroblasts and myocytes? Eur Heart J. 2010;31:1771–9.

    Article  CAS  Google Scholar 

  26. Aoki J, Ikari Y, Nakajima H, et al. Clinical and pathologic characteristics of dilated cardiomyopathy in hemodialysis patients. Kidney Int. 2005;67:333–40.

    Article  Google Scholar 

  27. Yoshizawa S, Uto K, Nishikawa T, et al. Histological features of endomyocardial biopsies in patients undergoing hemodialysis: comparison with dilated cardiomyopathy and hypertensive heart disease. Cardiovasc Pathol. 2020;49:107256.

    Article  CAS  Google Scholar 

  28. Inaguma D, Koide S, Takahashi K, et al. Association between resting heart rate just before starting the first dialysis session and mortality: a multicentre prospective cohort study. Nephrology (Carlton). 2018;23:461–8.

    Article  CAS  Google Scholar 

  29. Kopple JD. Nutritional status as a predictor of morbidity and mortality in maintenance dialysis patients. Asaio J. 1997;43:246–50.

    CAS  PubMed  Google Scholar 

  30. Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73:391–8.

    Article  CAS  Google Scholar 

  31. Don BR, Kaysen G. Serum albumin: relationship to inflammation and nutrition. Semin Dial. 2004;17:432–7.

    Article  Google Scholar 

  32. Leon JB, Majerle AD, Soinski JA, et al. Can a nutrition intervention improve albumin levels among hemodialysis patients? A pilot study. J Ren Nutr. 2001;11:9–15.

    Article  CAS  Google Scholar 

  33. Leon JB, Albert JM, Gilchrist G, et al. Improving albumin levels among hemodialysis patients: a community-based randomized controlled trial. Am J Kidney Dis. 2006;48:28–36.

    Article  Google Scholar 

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Acknowledgements

We would like to express our thanks to the patients who participated in this study and their families. We also thank Emi Hanai and all the clinical technologists and sonographers who performed the echocardiography, and all the doctors who managed the dialysis at Masuko Memorial Hospital.

Funding

This study was not supported by any grants.

Author information

Authors and Affiliations

  1. Department of Cardiology, Masuko Memorial Hospital, 35-28 Takehashi-cho, Nakamura-ku, Nagoya, Aichi, 453-8566, Japan

    Takafumi Nakayama, Junki Yamamoto & Yoshihiro Seo

  2. Department of Nephrology, Masuko Memorial Hospital, Nagoya, Japan

    Toshikazu Ozeki, Kaoru Yasuda, Chikao Yamazaki & Kunio Morozumi

  3. Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    Takafumi Nakayama, Junki Yamamoto, Tsuyoshi Ito, Toshihiko Goto & Yoshihiro Seo

  4. Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Toshikazu Ozeki & Shoichi Maruyama

Authors
  1. Takafumi Nakayama
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  2. Junki Yamamoto
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  3. Toshikazu Ozeki
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  4. Kaoru Yasuda
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  5. Chikao Yamazaki
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  6. Tsuyoshi Ito
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  7. Toshihiko Goto
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  9. Kunio Morozumi
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  10. Yoshihiro Seo
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Corresponding author

Correspondence to Yoshihiro Seo.

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Conflict of interest

Yoshihiro Seo is a member of Journal of Medical Ultrasonics’ editorial team. The other authors declare no conflicts of interest associated with this study.

Ethical statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study (The information in this retrospective study is available on the Masuko Memorial Hospital website, and all patients are given the opportunity to withdraw from the study).

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10396_2022_1197_MOESM5_ESM.tif

Supplementary file5 Figure S1. Survival curves for all-cause death according to the primary disease of diabetes mellitus and non-diabetes mellitus. Overall mortality was significantly higher among patients whose primary disease was diabetes mellitus compared to those with the primary disease of non-diabetes mellitus (TIF 104 KB)

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Nakayama, T., Yamamoto, J., Ozeki, T. et al. Impact of left ventricular hypertrophy on clinical outcomes in patients with dialysis: a single-center study in Japan. J Med Ultrasonics 49, 241–252 (2022). https://doi.org/10.1007/s10396-022-01197-4

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  • DOI: https://doi.org/10.1007/s10396-022-01197-4

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