REDUCED LEFT-VENTRICULAR HYPERTROPHY IN TYPE-1 DIABETIC-PATIENTS WITHEND-STAGE RENAL-FAILURE - A COMPARISON BETWEEN GROUPS INVESTIGATED 1977-80 AND 1991-93

Background. During the last decade, control of hypertension, oedema, a naemia, uraemia, and blood glucose has improved in patients with diabe tic nephropathy. We have investigated whether this has influenced card iac function at the time of end-stage renal failure. Study design. Ech ocardiographic investigations were performed in 26 type 1 diabetic pat ients evaluated for kidney transplantation and the results compared wi th those obtained in healthy controls and in a similar group of patien ts investigated in 1977-1980. Results. Blood pressure was 153 +/- 21/8 5 +/- 12 mmHg versus 174 +/- 17/91 +/- 9 (recent group versus early gr oup). The left ventricular (LV) diameter index, a measure of volaemia, was increased in systole and diastole in the early but not in the rec ent group. Both groups had LV hypertrophy, but this was much less pron ounced in the recent group; posterior wall thickness was 1.1 +/- 0.16 cm versus 1.3 +/- 0.26 cm (P = 0.0001) and LV mass index 132 +/- 43 g/ m(2) versus 166 +/- 44 g/m(2) (P = 0.009). Blood pressure correlated s ignificantly with indices of LV hypertrophy in the recent group. Systo lic function was normal in both groups but diastolic function was dist urbed in both and to the same extent, atrial systole contributing by 2 7 +/- 14% to ventricular filling. Conclusion. Better treatment of hype rtension, fluid overload, and uraemia has led to less pronounced LV hy pertrophy. The remaining correlation with blood pressure suggests that more could be gained by intensified antihypertensive treatment.