Abstract: FR-PO852

The Impact of Left Ventricular Hypertrophy and Left Ventricular Geometry at Dialysis Initiation on Cardiovascular Events on Chronic Dialysis in Japanese CKD Patients

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Takatsuka, Taisuke, Osaka General Medical Center, Osaka-Shi, Osaka-Fu, Japan
  • Yoshimura, Daisuke, Osaka General Medical Center, Osaka-Shi, Osaka-Fu, Japan
  • Iwata, Yukimasa, Osaka General Medical Center, Osaka-Shi, Osaka-Fu, Japan
  • Okushima, Hiroki, Osaka General Medical Center, Osaka-Shi, Osaka-Fu, Japan
  • Iio, Rei, Osaka General Medical Center, Osaka-Shi, Osaka-Fu, Japan
  • Shoji, Tatsuya, Osaka General Medical Center, Osaka-Shi, Osaka-Fu, Japan
  • Hayashi, Terumasa, Osaka General Medical Center, Osaka-Shi, Osaka-Fu, Japan
Background

Although, left ventricular hypertrophy (LVH) is common and worsens as CKD stage progresses and is an independent predictor of mortality and cardiovascular events (CVE) in CKD patients on dialysis, there are conflicting reports on the association between left ventricular geometry (LVG) and clinical outcomes. Thus, we conducted retrospective cohort study in incident dialysis patients at two major tertiary referral hospitals in Japan to investigate the impact of LVH and LVG at dialysis initiation on CVE on chronic dialysis.

Methods

Study population comprised 371 and 400 consecutive patients who started maintenance dialysis from 2006 to 2015 at our hospital and from 2001 to 2009 at Rinku General Medical Center, respectively. Echocardiogram was basically performed just before dialysis initiation. We categorized into four groups using LVH [left ventricular mass index (LVMI) >49g/m2.7 for men and >45g/m2.7 for women] and relative wall thickness [≥0.42 or <0.42]; normal geometry (NG), concentric remodeling (CR), eccentric hypertrophy (EH), concentric hypertrophy (CH). We compared patients’ status at dialysis initiation among four groups and Cox proportional hazard model was used to investigate the association of LVH and LVG with CVE on chronic dialysis.

Results

Median age was 69 (male, 60.4%) and eGFR was 4.9ml/min/1.73m2. Median ejection fraction (EF) and LVMI were 64.1% and 60.8g/m2.7, respectively. Among 771 patients, 81 (10.5%), 56 (7.3%), 322 (41.7%) and 312 (40.5%) were classified into NG, CR, EH and CH, respectively. Multivariate Cox model showed that male gender, history of heart failure, Hemoglobin and EF were independently associated with CVE, whereas LVMI and LVG were not. Subgroup analysis revealed that EF (P 0.004) and history of heart failure (P <0.001) had significant interactions on the association of LVMI with CVE.

Conclusion

LVG at dialysis initiation was not associated with CVE on chronic dialysis. On the other hand, LVMI may be predictive for CVE in patients with preserved cardiac function or without history of heart failure.