[Left ventricular hypertrophy in patients on hemodialysis: importance of anemia].

BACKGROUND

Cardiovascular diseases are the most frequent cause of mortality in hemodialysis patients. Left ventricular hypertrophy is the main risk factor for development of cardiovascular morbidity and mortality in patients on hemodialysis. Anemia is the only main risk factor for the development of left ventricular hypertrophy in patients on hemodialysis. The aim of this study was to examine the impact of anemia in the development of left ventricular hypertrophy, and correlation between anemia and echocardiographic parameters for the assessment of left ventricular hypertrophy.

METHODS

The research was conducted on 115 patients (M:F 71:44) regularly treated by hemodialysis, average age 53.30+/-1.2.17 years, average length of dialysis 4.51+/-4.01 years and average Kt/Vsp index 1.17+/-0.23. Depending on the level of hemoglobin, the patients were divided into three groups. The basic parameters investigated were the following: hemoglobin, hematocrite, serum concentrations of albumin, CRP, total cholesterol, HDL cholesterol, LDL cholesterol, and triglyceride serum concentrations, parathormon, diastolic thickness of interventricular septu-mIVSd, diastolic thickness of left ventricular posterior wall, relative wall thickness-RWT, left ventricular mass index-LVMi, index of left ventricular end-diastolic volume-iLVEDV. The results were statistically analyzed using ANOVA, Kruskal-Wallis test, Student t-test, Mann-Whitney U test, Univariate logistic regression analysis test, and Multivariate logistic regression analysis test.

RESULTS

The patients with hemoglobin <80 g/l had a very significantly higher (p<0.01), while the patients with hemoglobin 80-100 g/l had a significantly higher (p<0.05) left ventricular mass index than patients with hemoglobin >100 g/l. The univariate logistic regression analysis has showed that lower HDL cholesterol, anemia, higher systolic arterial pressure and higher mean arterial pressure cumulatively lead to the development of left ventricular hypertrophy. Multivariate logistic regression analysis established anemia as an independent risk factor for the development of left ventricular hypertrophy.

CONCLUSIONS

Anemia is an independent risk factor for the development left ventricular hypertrophy. Identification of patients with increased risk for development of left ventricular hypertrophy and application of appropriate therapy to attain target values of risk factors, result in the regression of left ventricular hypertrophy, reduced cardiovascular morbidity and mortality rates and improved quality of life in patients treated with regular hemodialyses.