REGRESSION OF LEFT-VENTRICULAR HYPERTROPHY IN HEMODIALYSIS-PATIENTS BY ULTRAFILTRATION AND REDUCED SALT INTAKE WITHOUT ANTIHYPERTENSIVE DRUGS

Background. Left ventricular hypertrophy (LVH) is very frequent in hae modialysis patients. Only few investigations have reported its regress ion, and only by the use of antihypertensive drugs. Because volume loa d is at least as important as pressure load, we investigated whether p ersistent strict volume control by ultrafiltration alone may be effect ive in improving LVH Methods. Using blood pressure (BP) and cardiac di mensions as a guide, we treated all hypertensive patients in our dialy sis unit during the 3 times weekly dialysis sessions for 4 h per sessi on with as much ultrafiltration as they could stand. If they gained to o much weight an extra isolated ultrafiltration (UF) session was appli ed. Special attention was given to dietary salt restriction. The study group of all 15 patients in whom echocardiographic assessment had bee n made at least 1.5 years previously was selected retrospectively, and we acknowledge that important confounding factors might not have been controlled for. Cardiothoracic index (CTI) was estimated on the chest X-ray. Diameters of left atrium (LA), left ventricle systolic (LVS) a nd diastolic (LVD), interventricular septum (IVS), posterior wall (PW) , and left ventricular mass index (LVMI) were estimated by standard ec hocardiographic methods. Results. Mean arterial pressure of the study group had been lowered by UF before the first echocardiogram from pred ialysis 136 +/- 11 to 101 +/- 14 and from postdialysis 119 +/- 8 to 92 +/- 12 mmHg. During a mean follow-up period of 37 +/- 11 months LVMI decreased from 175 +/- 60 to 105 +/- 11 g/m(2). CTI decreased further from 48 +/- 3 to 43 +/- 4%, while significant decreases of LA (22.5 +/ - 3 to 19.9 +/- 4 mm/m(2)), LVS (18.7 +/- 4 to 15.9 +/- 3 mm/m(2)) and LVD (28.3 +/- 4 to 24.0 +/- 3 mm/m(2)) were seen in all patients. The re also was a further decrease in both pre-and postdialysis BP to 116 +/- 12/73 +/- 7 and 105 +/- 7/65 +/- 3 mmHg respectively. Conclusion. The results of this uncontrolled retrospective study suggest that good long-term BP control and a decrease of LVM can be achieved by continu ous efforts to control hypervolaemia. The decrease in volume may be ev en more important than pressure reduction to achieve this goal.