Clinical correlates and mortality impact of left ventricular hypertrophy among new ESRD patients in the United States.

BACKGROUND

Left ventricular hypertrophy (LVH) is common among patients with end-stage renal disease (ESRD), but few population-based studies exist. Here, we describe clinical correlations and mortality impact of LVH in new patients with ESRD from the Dialysis Morbidity and Mortality Study Wave 2.

METHODS

Echocardiographic data denoting the presence or absence of LVH were available for 64% (n = 2,584) of the entire cohort. Multivariate logistic regression identified significant correlates of LVH, and Cox proportional hazards regression estimated the mortality risk (risk ratio [RR]) for LVH at 6, 12, and 24 months.

RESULTS

The prevalence of LVH was 16.4%. Multivariate analysis identified age (adjusted odds ratio [OR], 1.15 per 10 years older), hypertension (OR, 1.39), diabetes (OR, 1.47), tobacco use (OR, 1.42), serum calcium level (OR, 1.17 per 1 mg/dL [0.25 mmol/L] higher), parathyroid hormone level greater than versus less than 157 pg/mL (157 ng/L; OR, 1.53), serum albumin level (OR, 1.38 per 1 g/dL [10 g/L] lower), and presence of pericarditis (OR, 2.55) as significant disease correlates. The impact of LVH on subsequent mortality was greatest in the first 6 months of follow-up (RR, 1.61; confidence interval [CI], 1.17 to 2.22) and became less pronounced thereafter (RR, 1.36; CI, 1.07 to 1.89; RR, 1.29; CI, 1.07 to 1.56 at the end of 1 and 2 years, respectively).

CONCLUSIONS

This study identifies known coronary risk factors and markers of uremia as independent correlates of LVH presence in new patients with ESRD. It also highlights the adverse impact of pre-ESRD LVH on short-term patient survival. Given the clinical consequences of LVH on morbidity and mortality, greater efforts are required to reduce known risk factors for LVH in the pre-ESRD period.