Bülent KAYA, Saime PAYDAS, Neslihan SEYREK, Mustafa BALAL, İbrahim KARAYAYLALI

Kronik böbrek hastalarında anormal kalp geometrisi ve sol ventrikül hipertrofisi

Amaç: Bu çalışmanın amacı kronik böbrek hastalığı (KBH) olan hastalarda sol ventrikül geometrisi (SVG) çeşit ve sıklığını araştırmaktır.Gereç ve Yöntem: Evre 2-5 KBH’lı, yaşı 17-79 aralığında, 100’ü erkek toplam 162 hasta çalışmaya dahil edildi. SVG ekokardiyografik parametrelere göre; sol ventrikül normal geometrisi (SVNG), sol ventrikül konsantrik remodelling (SVKR), konsatrik sol ventrikül hipertrofisi (SVKH) ve eksantrik sol ventrikül hipertrofisi (ESVH) olarak hesaplandı.Bulgular: Hastalarımızda SVH sıklığı % 45.1 idi. SVG paternleri: ESVH 18 (% 11.1), KSVH 42 (% 25.9), SVKR 51 (% 31.5) ve SVNG 51 (% 31.5) saptandı. SVNG evre 2 KBH ve diyaliz hastalarında sırasıyla %10.38 ve %34.27 idi. SVKR, evre 2 KBH’da yüksek sıklıkta (% 62.3) saptandı. Non-diyaliz evre 5 KBH ve diyaliz hastalarında KSVH ve ESVH sıklığı sırasıyla % 35.92 ve % 29.13 bulundu. Klinik özellikler ile SVG değerlendirildiğinde; yaş ve GFR SVKR ile, HbA1C, serum albumin ve sodyum seviyeleri KSVH ile, yaş ve serum albumin ESVH ile ilişkiliydi.Sonuç: KBH hastalarımızda, evre 2 KBH aşamasında bile anormal SVG saptandı. KBH’ın ileri evrelerinde KSVH ve ESVH insidansı daha yüksekti. Volum durumu ve beslenme gibi geleneksel olmayan faktörler de sol ventrikül yeniden şekillenmesinde önemliydi.

Abnormal geometry and hypertrophy of left ventricle in patients with chronic kidney disease

Purpose: The aim of this study was to investigate the incidence of left ventricular geometric patterns in patients with chronic kidney disease (CKD).Materials and Methods: A total of 162 patients (100 males) with stage 2–5 CKD were included in the study. Patient age was between 17 and 79 years. Left ventricular geometry (LVG) patterns were calculated as left ventricular normal geometry (LVNG), left ventricular concentric remodeling (LVCR), concentric left ventricular hypertrophy (cLVH) and eccentric left ventricular hypertrophy (eLVH) by echocardiographic parameters.Results: The incidence of LVH was 45.1%. LVG patterns were found as follows: eLVH in patients 18(11.1%), cLVH in 42(25.9%), LVCR in 51(31.5%), and LVNG 51(31.5%). LVNG was found 10.38% and 34.27% in CKD stage 2 and dialysis, respectively. LVCR was as high as 62.3% in CKD stage2. cLVH and eLVH were found as 35.92% and 29.13% in stage 5 non-dialysis and dialysis, respectively. There was a relationship between clinical characteristics and LVG as follows age and GFR with LVCR, HbA1C and serum levels of albumin and sodium with cLVH, and age and serum albumin with eLVHConclusions: In our CKD patients, abnormal LVG was found as earlier as CKD stage 2. The incidence of cLVH and eLVH was higher in advanced stages of CKD. Nontraditional factors such as volume status and nutrition were also crucial for left ventricular remodeling.

Keywords:

Left ventricular geometry, Left venticular hypertrophy, Chronic Kidney Disease,

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1. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol. 1998;9:16-23.
2. Shlipak MG, Fried LF, Cushman M, Manolio TA, Peterson D, Stehman-Breen C et al. Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA. 2005;293:1737-45.
3. National Cholesterol Education Program Expert Panel on Detection E, Treatment of High Blood Cholesterol in A. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143- 421.
4. Ravarotto V, Simioni F, Pagnin E, Davis PA, Calo LA. Oxidative stress - chronic kidney disease - cardiovascular disease: A vicious circle. Life Sci. 2018;210:125-31.
5. Ardahanli I, Celik M. Can myocardial performance index predict early cardiac risks in erectile dysfunction? Aging Male 2020; doi: 10.1080/13685538.2020.1768367:1-7.
6. London GM. Cardiovascular disease in chronic renal failure: pathophysiologic aspects. Semin Dial. 2003;16:85-94.
7. Zoccali C, Benedetto FA, Mallamaci F, Tripepi G, Giacone G, Stancanelli B et al. Left ventricular mass monitoring in the follow-up of dialysis patients: prognostic value of left ventricular hypertrophy progression. Kidney Int. 2004;65:1492-8.
8. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322:1561-6.
9. Park CW, Shin YS, Kim CM, Lee SY, Yu SE, Kim SY et al. Increased C-reactive protein following hemodialysis predicts cardiac hypertrophy in chronic hemodialysis patients. Am J Kidney Dis. 2002;40:1230-9.
10. Chirakarnjanakorn S, Navaneethan SD, Francis GS, Tang WH. Cardiovascular impact in patients undergoing maintenance hemodialysis: Clinical management considerations. Int J Cardiol. 2017;232:12-23.
11. Paoletti E, Bellino D, Cassottana P, Rolla D, Cannella G. Left ventricular hypertrophy in nondiabetic predialysis CKD. Am J Kidney Dis. 2005;46:320-7.
12. Malyala R, Rapi L, Nash MM, Prasad GVR. Pretransplant left ventricular geometry and major adverse cardiovascular events after kidney transplantation. Ann Transplant. 2019;24:100-7.
13. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440- 63.
14. Park M, Hsu CY, Li Y, Mishra RK, Keane M, Rosas SE, et al. Associations between kidney function and subclinical cardiac abnormalities in CKD. J Am Soc Nephrol. 2012;23:1725-34.
15. Bansal N, Keane M, Delafontaine P, Dries D, Foster E, Gadegbeku CA et al. A longitudinal study of left ventricular function and structure from CKD to ESRD: the CRIC study. Clin J Am Soc Nephrol. 2013;8:355-62.
16. de Roij van Zuijdewijn CL, Hansildaar R, Bots ML, Blankestijn PJ, van den Dorpel MA, Grooteman MP et al. Eccentric left ventricular hypertrophy and sudden death in patients with end-stage kidney disease. Am J Nephrol. 2015;42:126-33.
17. Lieb W, Gona P, Larson MG, Aragam J, Zile MR, Cheng S et al. The natural history of left ventricular geometry in the community: clinical correlates and prognostic significance of change in LV geometric pattern. JACC Cardiovasc Imaging. 2014;7:870-8.
18. Eckardt KU, Scherhag A, Macdougall IC, Tsakiris D, Clyne N, Locatelli F et al. Left ventricular geometry predicts cardiovascular outcomes associated with anemia correction in CKD. J Am Soc Nephrol. 2009;20:2651-60.
19. Paoletti E, De Nicola L, Gabbai FB, Chiodini P, Ravera M, Pieracci L et al. Associations of left ventricular hypertrophy and geometry with adverse outcomes in patients with CKD and hypertension. Clin J Am Soc Nephrol 2016; 11:271-9.
20. National Kidney F. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39:1-266.
21. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450-8.
22. Lorell BH, Carabello BA. Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 2000; 102:470-9.
23. Chen SC, Huang JC, Tsai YC, Chen LI, Su HM, Chang JM et al. Body Mass Index, Left Ventricular Mass Index and Cardiovascular Events in Chronic Kidney Disease. Am J Med Sci. 2016;351:91-6.
24. Foley RN, Parfrey PS, Kent GM, Harnett JD, Murray DC, Barre PE. Serial change in echocardiographic parameters and cardiac failure in end-stage renal disease. J Am Soc Nephrol. 2000;11:912-6.
25. McCullough PA, Chan CT, Weinhandl ED, Burkart JM, Bakris GL. Intensive hemodialysis, left ventricular hypertrophy, and cardiovascular disease. Am J Kidney Dis. 2016;68:5-14.
26. Chan CT, Floras JS, Miller JA, Richardson RM, Pierratos A. Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int. 2002;61:2235-9.
27. Ayus JC, Mizani MR, Achinger SG, Thadhani R, Go AS, Lee S. Effects of short daily versus conventional hemodialysis on left ventricular hypertrophy and inflammatory markers: a prospective, controlled study. J Am Soc Nephrol. 2005;16:2778-88.
28. Rocco MV, Lockridge RS, Jr., Beck GJ, Eggers PW, Gassman JJ, Greene T et al. The effects of frequent nocturnal home hemodialysis: the Frequent Hemodialysis Network Nocturnal Trial. Kidney Int. 2011;80:1080-91.
29. Vigan J, Ahoui S, Hounsou D, Goudote ACK, Vehounkpe Sacca J. Left ventricular hypertrophy in chronic hemodialysis patients at CNHU-HKM of Cotonou. Nephrol Ther. 2018; 14:29-34.
30. Bregman R, Lemos C, Pecoits Filho R, Abensur H, Draibe S, Bastos MG et al. Left ventricular hypertrophy in patients with chronic kidney disease under conservative treatment. J Bras Nefrol. 2010;32:83-8.
31. Dobre M, Roy J, Tao K, Anderson AH, Bansal N, Chen J et al. Serum bicarbonate and structural and functional cardiac abnormalities in chronic kidney disease - a report from the Chronic Renal Insufficiency Cohort Study. Am J Nephrol. 2016;43:411-20.
32. Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The prognostic importance of left ventricular geometry in uremic cardiomyopathy. J Am Soc Nephrol. 1995;5:2024-31.
33. Nube MJ, Hoekstra T, Doganer V, Bots ML, Blankestijn PJ, van den Dorpel M et al. Left ventricular geometric patterns in end-stage kidney disease: Determinants and course over time. Hemodial Int 2018; doi: 10.1111/hdi.12644.
34. Park SK, Jung JY, Kang JG, Chung PW, Ryoo JH. Mildly decreased renal function and its relation to left ventricular geometry change. Circ J. 2019;83:2236-41.
35. Alves FC, Sun J, Qureshi AR, Dai L, Snaedal S, Barany P et al. The higher mortality associated with low serum albumin is dependent on systemic inflammation in end-stage kidney disease. PLoS One. 2018;13:e0190410.
36. Perunicic-Pekovic G, Rasic-Milutinovic Z, Pljesa S. [Predictors of mortality in dialysis patients-- association between malnutrition, inflammation and atherosclerosis (MIA syndrome)]. Med Pregl. 2004;57:149-52.
37. 7. Stenvinkel P, Heimburger O, Paultre F, Diczfalusy U, Wang T, Berglund L et al. Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int. 1999;55:1899-911.
38. Agarwal R. Hypervolemia is associated with increased mortality among hemodialysis patients. Hypertension. 2010;56:512-7.
39. Petrie JR, Guzik TJ, Touyz RM. Diabetes, hypertension, and cardiovascular disease: clinical insights and vascular mechanisms. Can J Cardiol. 2018;34:575-84.
40. Glezeva N, Chisale M, McDonald K, Ledwidge M, Gallagher J, Watson CJ. Diabetes and complications of the heart in Sub-Saharan Africa: An urgent need for improved awareness, diagnostics and management. Diabetes Res Clin Pract. 2018;137:10-9.
41. Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol. 2005;25:932-43.
42. McEniery CM, Wilkinson IB, Avolio AP. Age, hypertension and arterial function. Clin Exp Pharmacol Physiol. 2007;34:665-71.
43. Paneni F, Diaz Canestro C, Libby P, Luscher TF, Camici GG. The aging cardiovascular system: understanding it at the cellular and clinical levels. J Am Coll Cardiol. 2017;69:1952-67.