Outcome and risk factors for left ventricular disorders in chronic uraemia

BACKGROUND: Left ventricular disease occurs frequently in dialysis patients.It may be manifest as concentric LV hypertrophy, LV dilatationwith or without LV hypertrophy, or systolic dysfunction. Littleis known concerning the clinical outcome and risk factors forthese disorders. METHODS: A cohort of 432 end-stage renal disease patients who survivedat least 6 months had an echo-cardiogram on initiation of dialysistherapy. Clinical, laboratory and echocardiographic data wasobtained annually during follow-up. RESULTS: On initiation of ESRD therapy 16% of patients had systolic dysfunction,41% concentric LV hypertrophy, 28% LV dilatation, and only 16%had normal echocardiograms. Median time to development of heartfailure was 19 months in patients with systolic dysfunction,38 months in concentric LV hypertrophy and 38 months in LV dilatation.The relative risks of heart failure in the three groups weresignificantly worse than in the normal group, after adjustingfor age, diabetes and ischaemic heart disease. Median survivalwas 38 months in systolic dysfunction, 48 months in concentrichypertrophy, 56 months in LV dilatation, and >66 months inthe normal group. Two hundred and seventy-five patients had a follow-up echocardiogram17 months after starting dialysis therapy together with serialmeasurement of potential risk factors prior to the echocardiogram.On follow-up echocardiogram the degree of concentric LV hypertrophywas independently related to hypertension while on dialysis,older age, and anaemia while on dialysis; the degree of LV dilatationwas related to ischaemic heart disease, anaemia, hypertensionand hypoalbuminemia while on dialysis; the degree of systolicdysfunction was associated with ischaemic heart disease andanaemia during follow-up. CONCLUSIONS: Manifestations of left ventricular disease are frequent andpersistent in chronic uraemia, and are associated with highrisks of heart failure and death. Potentially reversible riskfactors include anaemia, hypertension, hypoalbuminaemia andischaemic heart disease.