Document Detail

Left ventricular hypertrophy in nondiabetic predialysis CKD.
MedLine Citation:
PMID:  16112052     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although left ventricular hypertrophy (LVH) is a strong predictor of mortality in patients with end-stage renal disease, few studies are available before the start of dialysis treatment. The purpose of this study is to evaluate the prevalence and clinical correlates of LVH in nondiabetic patients with chronic kidney disease (CKD) not yet undergoing renal replacement therapy. METHODS: We investigated 244 nondiabetic patients with CKD; 57 patients (42 men; age, 20 to 78 years) had stages 1 to 2 CKD and 187 patients (122 men; age, 18 to 77 years) had stages 3 to 5 CKD. Fifty-two normotensive healthy subjects served as controls. Each patient had blood pressure (BP) measured by means of 24-hour ambulatory BP monitoring and left ventricular mass index (LVMi) assessed by means of M-mode echocardiography. Creatinine clearance was estimated by means of the Cockcroft-Gault formula, and hemoglobin, serum lipid, and intact parathyroid hormone concentrations and daily urinary protein excretion were assessed by using routine methods. RESULTS: In the overall group, prevalences of arterial hypertension and LVH were 66% and 74%, respectively. LVMi was 160 +/- 50 g/m2 body surface area and associated directly with age (P = 0.0013), duration of arterial hypertension (P = 0.0075), 24-hour systolic BP (P = 0.0113), pulse pressure (P = 0.0003), daytime (P = 0.0206) and nighttime systolic BP (P = 0.0059), and urinary protein excretion (P < 0.05) and inversely with creatinine clearance (P = 0.0103) and hemoglobin level (P = 0.0276). In patients with CKD stages 1 to 2 (LVH prevalence, 51%), age, duration of arterial hypertension, pulse pressure, and urinary protein excretion were significant predictors of LVMi (P < 0.00002) by using stepwise regression analysis, whereas in those with CKD stages 3 to 5 (LVH prevalence, 78%), pulse pressure emerged as the sole predictor of LVMi (P = 0.0011). CONCLUSION: The prevalence of LVH in nondiabetic predialysis patients with CKD is greater than previously reported, and there is evidence that LVH already is present in the early stages of renal disease. Arterial hypertension is associated with LVH in patients with CKD, and the strong relationship between elevated pulse pressure and LVH in those with more advanced CKD suggests that increased arterial stiffness might have a role for LVH well before the start of dialysis therapy.
Ernesto Paoletti; Diego Bellino; Paolo Cassottana; Davide Rolla; Giuseppe Cannella
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  46     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-22     Completed Date:  2005-10-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  320-7     Citation Subset:  IM    
Divisionse di Nefrologia, Dialisi e Trapianto and Cardiologia, Azienda Ospedaliera Universitaria S Martino, Genova, Italy.
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MeSH Terms
Antihypertensive Agents / therapeutic use
Blood Pressure
Chronic Disease
Cohort Studies
Cross-Sectional Studies
Hyperlipidemias / epidemiology
Hypertension / drug therapy,  epidemiology,  physiopathology
Hypertrophy, Left Ventricular / epidemiology*,  etiology,  physiopathology,  ultrasonography
Italy / epidemiology
Kidney Diseases / epidemiology*
Middle Aged
Severity of Illness Index
Vascular Resistance
Reg. No./Substance:
0/Antihypertensive Agents
Comment In:
Am J Kidney Dis. 2005 Dec;46(6):1148; author reply 1148-9   [PMID:  16310583 ]

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