OUTCOME AND RISK-FACTORS FOR LEFT-VENTRICULAR DISORDERS IN CHRONIC UREMIA

Background. Left ventricular disease occurs frequently in dialysis pat ients. It may be manifest as concentric LV hypertrophy, LV dilatation with or without LV hypertrophy, or systolic dysfunction. Little is kno wn concerning the clinical outcome and risk factors for these disorder s. Methods. A cohort of 432 end-stage renal disease patients who survi ved at least 6 months had an echocardiogram on initiation of dialysis therapy. Clinical, laboratory and echocardiographic data was obtained annually during follow-up. Results. On initiation of ESRD therapy 16% of patients had systolic dysfunction, 41% concentric LV hypertrophy, 2 8% LV dilatation, and only 16% had normal echocardiograms. Median time to development of heart failure was 19 months in patients with systol ic dysfunction, 38 months in concentric LV hypertrophy and 38 months i n LV dilatation. The relative risks of heart failure in the three grou ps were significantly worse than in the normal group, after adjusting for age, diabetes and ischaemic heart disease. Median survival was 38 months in systolic dysfunction, 48 months in concentric hypertrophy, 5 6 months in LV dilatation, and >66 months in the normal group. Two hun dred and seventy-five patients had a followup echocardiogram 17 months after starting dialysis therapy together with serial measurement of p otential risk factors prior to the echocardiogram. On followup echocar diogram the degree of concentric LV hypertrophy was independently rela ted to hypertension while on dialysis, older age, and anaemia while on dialysis; the degree of LV dilatation was related to ischaemic heart disease, anaemia, hypertension and hypoalbuminemia while on dialysis; the degree of systolic dysfunction was associated with ischaemic heart disease and anaemia during follow-up. Conclusions. Manifestations of left ventricular disease are frequent and persistent in chronic uraemi a, and are associated with high risks of heart failure and death. Pote ntially reversible risk factors include anaemia, hypertension, hypoalb uminaemia and ischaemic heart disease.