Document Detail


Should the preservation of residual renal function cost volume overload and its consequence left ventricular hypertrophy in new hemodialysis patients?
MedLine Citation:
PMID:  15462109     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Left ventricular hypertrophy (LVH) is an important predictor of mortality in dialysis patients. The loss of residual renal function (RRF) appears to occur more rapidly in hemodialysis than continuous ambulatory peritoneal dialysis (CAPD). It is more likely that volume expansion in patients on CAPD may preserve RRF. The aim of this study was to investigate whether there is a cause-effect relationship between volume overload and preserving RRF in new hemodialysis patients. METHODS: Nineteen patients with end-stage renal disease (ESRD) starting hemodialysis therapy were included in the study. At the beginning, their elevated blood pressures (BP) were treated with antihypertensive drugs. Thereafter, until normovolemia and normal BP were obtained, strict volume control was applied. The effects of both treatment modalities on the loss of RRF and LVH were evaluated prospectively. RESULTS: At the initial examination, all of the patients were hypertensive and had markedly increased left ventricular mass index (LVMI). The daily urine production was 1575+/-281 mL. At the end of drug treatment period lasting three months, although BP significantly decreased, daily urine production and LVMI only decreased by 12% and 6%, respectively. At the end of the period in which strict volume control was applied, the body weight significantly decreased (from 60+/-5 to 55+/-8 kg, p<0.0001). This decrease in body weight was accompanied by marked decreases in dilated cardiac chamber size and more importantly daily urine production. At the end of this period, while 7 of 19 patients had no residual urine production, residual urine production was below 200 mL/d in the remaining 12 patients. Although the period of volume control was short, there was significant reduction in the LVMI (decreased from 251+/-59 to 161+/-25 gr/m2, p<0.0001). CONCLUSION: The results of our prospective study have clearly shown that the persistence of residual renal function in patients with ESRD starting hemodialysis therapy may largely depend on volume overload. Equally interesting was the finding that despite significantly reduced BP level with hypotensive drugs, there was no marked regression in LVMI. In the contrary, after the volume control period, LVMI was significantly decreased. Our results support the hypotheses that decrease in volume may be more important than pressure reduction in regressing the left ventricular hypertrophy.
Authors:
Ali Ihsan Gunal; Ercan Kirciman; Murat Guler; Mustafa Yavuzkir; Huseyin Celiker
Related Documents :
19640349 - Target blood pressure attainment in diabetic hypertensive patients: need for more diure...
11926349 - Excess morbidity and cost of failure to achieve targets for blood pressure control in e...
10449889 - Long-term potential of angiotensin receptor blockade for cardiovascular protection in h...
17998769 - Bedtime administration of cilnidipine controls morning hypertension.
16034219 - Time spent moving is related to systolic blood pressure among older women.
19000959 - Impact of patient-general practitioner short-messages-based interaction on the control ...
8280539 - Re-expansion of atelectasis during general anaesthesia: a computed tomography study.
12569269 - Atorvastatin causes depressor and sympatho-inhibitory effects with upregulation of nitr...
17309949 - Do statins reduce blood pressure?: a meta-analysis of randomized, controlled trials.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Renal failure     Volume:  26     ISSN:  0886-022X     ISO Abbreviation:  Ren Fail     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-10-06     Completed Date:  2005-04-05     Revised Date:  2008-05-21    
Medline Journal Info:
Nlm Unique ID:  8701128     Medline TA:  Ren Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  405-9     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Firat University Medical School, Elazig, Turkey. igunal@yahoo.com
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Female
Follow-Up Studies
Humans
Hypertension / etiology,  physiopathology
Hypertrophy, Left Ventricular / etiology*,  physiopathology
Kidney / physiopathology*
Kidney Failure, Chronic / physiopathology*,  therapy
Kidney Function Tests
Male
Middle Aged
Prospective Studies
Renal Dialysis / adverse effects*
Water-Electrolyte Imbalance / complications*,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Comparative effects of fosinopril and irbesartan on hematopoiesis in essential hypertensives.
Next Document:  Safety and efficacy of fluvastatin in hyperlipidemic patients with chronic renal disease.