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Left ventricular hypertrophy and left atrial diameter are associated with mortality risk in haemodialysis patients: a retrospective cohort study

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Abstract

Background

Cardiovascular death is the main cause of death in patients with end-stage kidney disease (ESKD). Left ventricular hypertrophy (LVH) and left atrial diameter (LAD) enlargement are frequent cardiac alterations in patients with ESKD and are major risk factors for cardiovascular events. However, it remains unclear whether there is an association between combined LAD or LVH and all-cause or cardiovascular mortality in this population.

Methods

A single-centre, retrospective cohort study including 576 haemodialysis (HD) patients was conducted. Patients were evaluated by cardiac ultrasound, and the study cohort was divided into four groups according to LAD and LVH status: low LAD and non-LVH; low LAD and LVH; high LAD and non-LVH; and high LAD and LVH. We used Kaplan–Meier analysis and Cox proportional hazard regression to analyse all-cause and cardiovascular mortality after multivariate adjustment.

Results

LAD was associated with an increased risk of all-cause mortality (HR 2.371, 1.602–3.509; p < 0.001). No significant differences were found between LVH and the risk of all-cause mortality. Patients with high LAD and LVH had significantly greater all-cause and cardiovascular mortality than did those with low LAD and non-LVH after adjustments for numerous potential confounders (HR 3.080, 1.608–5.899; p = 0.001) (HR 4.059, 1.753–9.397; p = 0.001).

Conclusion

Among maintenance haemodialysis (MHD) patients, LAD was more strongly associated with mortality than was LVH. A high LAD and LVH are associated with a greater risk of mortality. Our results emphasize that the occurrence of LAD and LVH in combination provides information that may be helpful in stratifying the risk of MHD patients.

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Data availability

The datasets are available from the corresponding author upon reasonable request.

Code availability

Not applicable.

References

  1. Collins AJ, Foley RN, Gilbertson DT, Chen SC. United States renal data system public health surveillance of chronic kidney disease and end-stage renal disease. Kidney Int suppl. 2015;5(1):2–7.

    Article  Google Scholar 

  2. LaTonya J, Hickson, Sara M, Negrotto, Macaulay O, Christopher G. Echocardiography criteria for structural heart disease in patients with end-stage renal disease initiating haeemodialysis. J Am Coll Cardiol. 2016;67(10):1173–82.

    Article  Google Scholar 

  3. Kessler M, Zannad F, Lehert P, Grunfeld JP, Thuilliez C, Leizorovicz A, Lechat P. Predictors of cardiovascular events in patients with end-stage renal disease: an analysis from the Fosinopril in Dialysis study. Nephrol Dial Transplant. 2007;22(12):3573–9.

    Article  PubMed  Google Scholar 

  4. Chen SC, Chang JM, Liu WC, Huang JC, Tsai JC, Lin MY, Su HM, Hwang SJ, Chen HC. Echocardiographic parameters are independently associated with increased cardiovascular events in patients with chronic kidney disease. Nephrol Dial Transplant. 2012;27(3):1064–70.

    Article  CAS  PubMed  Google Scholar 

  5. Mccullough PA, Roberts WC. Influence of chronic renal failure on cardiac structure. J Am Coll Cardiol. 2016;67(10):1183–5.

    Article  PubMed  Google Scholar 

  6. Zhu J, Tang C, Ouyang H, Shen H, You T, Hu J. Prediction of all-cause mortality using an echocardiography-based risk score in haeemodialysis patients. Cardiorenal Med. 2021;11(1):33–43.

    Article  CAS  PubMed  Google Scholar 

  7. Tripepi G, Pannier B, D’Arrigo G, Mallamaci F, Zoccali C, London G. Reappraisal in two European cohorts of the prognostic power of left ventricular massindexin chronic kidney failure. Kidney Int. 2017;91(3):704–10.

    Article  PubMed  Google Scholar 

  8. Vakili BA, Okin PM, Devereux RB. Prognostic implications of left ventricular hypertrophy. Am Heart J. 2001;141(3):334–41.

    Article  CAS  PubMed  Google Scholar 

  9. Bouzas-Mosquera A, Broullon FJ, Alvarez-Garcia N, Mendez E, Peteiro J, Gandara-Sambade T, Prada O, Mosquera VX, Castro-Beiras A. Left atrial size and risk for all-cause mortality and ischaemiemic stroke. CMAJ : Can Med Assoc J. 2011;183(10):E657-664.

    Article  Google Scholar 

  10. Devereux R. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57(6):450–8.

    Article  CAS  PubMed  Google Scholar 

  11. Chamber Quantification Writing G, American Society of Echocardiography’s.G, Standards C, European Association of E, Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ. 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(12):1440–63.

    Article  Google Scholar 

  12. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Boehm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.

    Article  PubMed  Google Scholar 

  13. Quin Ones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15(2):167–84.

    Article  Google Scholar 

  14. Lang RM, Bierig M, Devereux RB. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Qua. J Am Soc Echocardiogr. 2005;18(12):1440–63.

    Article  PubMed  Google Scholar 

  15. Wang AY, Wang M, Woo J, Lam CW, Li PK, Lui SF, Sanderson JE. Cardiac valve calcification as an important predictor for all-cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol. 2003;14(1):159–68.

    Article  PubMed  Google Scholar 

  16. Parfrey PS, Foley RN, Harnett JD, Kent GM, Barre PE. Outcome and risk factors for left ventricular disorders in chronic uremia. Nephrol Dial Transplant. 1996;11(7):1277–85.

    Article  CAS  PubMed  Google Scholar 

  17. Harnett JD, Kent GM, Barre PE, Taylor R, Parfrey PS. Risk factors for the development of left ventricular hypertrophy in a prospectively followed cohort of dialysis patients. J Am Soc Nephrol. 1994;4(7):1486–90.

    Article  CAS  PubMed  Google Scholar 

  18. Guerin AP, Marchais SJ, Pannier B, Safar ME, Day M, Metivier F, London GM. Cardiac and arterial interactions in end-stage renal disease. Kidney Int. 1996;50(2):600–8.

    Article  PubMed  Google Scholar 

  19. Vlahakos DV, Hahalis G, Vassilakos P, Marathias KP, Geroulanos S. Relationship between left ventricular hypertrophy and plasma renin activity in chronic hemodialysis patients. J Am Soc Nephrol. 1997;8(11):1764–70.

    Article  CAS  PubMed  Google Scholar 

  20. Ernesto P, Claudia S, Giovanni DM, Diego B, Beatrice D, Paolo C, Giuseppe C. The worsening of left ventricular hypertrophy is the strongest predictor of sudden cardiac death in haemodialysis patients: a 10 year survey. Nephrol Dial Transplant. 2004;7:1829–34.

    Google Scholar 

  21. Foley RN, Parfrey PS, Kent GM, Harnett JD, Barre PE. Serial change in echocardiographic parameters and cardiac failure in end-stage renal disease. J Am Soc Nephrol. 2000;11(5):912–6.

    Article  PubMed  Google Scholar 

  22. Zoccali C. Left ventricular systolic function monitoring in asymptomatic dialysis patients: a prospective cohort study. J Am Soc Nephrol. 2006;17(5):1460–5.

    Article  PubMed  Google Scholar 

  23. London GM, Pannier B, Guerin AP, Blacher J, Marchais SJ, Darne B, Metivier F, Adda H, Safar ME. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol. 2001;12(12):2759–67.

    Article  PubMed  Google Scholar 

  24. Trinh E, Chan CT. Intensive home hemodialysis results in regression of left ventricular hypertrophy and better clinical outcomes. Am J Nephrol. 2016;44(4):300–7.

    Article  PubMed  Google Scholar 

  25. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, Tsang TSM. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol. 2006;47(12):2357–63.

    Article  PubMed  Google Scholar 

  26. Patel DA, Lavie CJ, Milani RV, Shah S, Gilliland Y. Clinical implications of left atrial enlargement: a review. Ochsner J. 2009;9(4):191–6.

    PubMed  PubMed Central  Google Scholar 

  27. Kedia G, Habibzadeh MR, Kudithipudi V, Molls F, Sorrell VL. Using traditional measurements of the left atrial diameter to predict the left atrial volume index. Echocardiography. 2010;25(1):36–9.

    Article  Google Scholar 

  28. Jun KS, Hyeok HS, Tak PJ, Jwa-Kyung K, Jung OH, Eun YD, Tae-Hyun Y, Shin-Wook K, Hun CK. Left atrial volume is an independent predictor of mortality in CAPD patients. Nephrol Dial Transplant. 2011;11:3732–9.

    Google Scholar 

  29. Agarwal R. (2012) Prevalence, determinants and prognosis of pulmonary hypertension among hemodialysis patients. Nephrol Dial Transplant. 2012;27:3908–14.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Stosovic MD, Petrovic MZ, Vujisic-Tesic BD, Stanojevic ML, Naumovic RT. Predictive value of echocardiography and its relation to Kt/V and anthropometric parameters in hemodialysis patients. Ren Fail. 2015;37(4):1–8.

    Article  Google Scholar 

  31. Zhang M, Zhang L, Hu Y, Wang Y, Xu S, Xie X, Xu T, Li Z, Jin H, Liu H. Sarcopenia and echocardiographic parameters for prediction of cardiovascular events and mortality in patients undergoing maintenance hemodialysis. PeerJ. 2022;10: e14429.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Qin Z, Yang Q, Yang M, Han M, Xiong Y, Liao R, Su B. Serum leptin concentration can predict cardiovascular outcomes and all-cause death in maintenance hemodialysis patients. Clin Chim Acta Int J Clin Chem. 2021;520:87–94.

    Article  CAS  Google Scholar 

  33. Vickery S, Price CP, Mbbchir RIJ, Abbas NA, Webb MC, Kempsonc ME, Lamb EJ. B-Type Natriuretic Peptide (BNP) and amino-terminal proBNP in patients with CKD: relationship to renal function and left ventricular hypertrophy. Am J Kidney Dis. 2005;46(4):610–20.

    Article  CAS  PubMed  Google Scholar 

  34. Yoshitomi R, Nakayama M, Sakoh T, Fukui A, Kitazono T. Plasma B-type natriuretic peptide concentration is independently associated with kidney function decline in Japanese patients with chronic kidney disease. J Hypertens. 2016;34(4):753–61.

    Article  CAS  PubMed  Google Scholar 

  35. Benjamin EJ, D’Agostino RB, Belanger AJ, Wolf PA, Levy D. Left atrial size and the risk of stroke and death. Fram Hear Study Circ. 1995;92(4):835–41.

    Article  CAS  Google Scholar 

  36. Szu-Chia C, Ho-Ming S, Yi-Chun T, Jiun-Chi H, Jer-Ming C, Shang-Jyh H, Hung-Chun C, Bruno C. Framingham risk score with cardiovascular events in chronic kidney disease. PLoS ONE. 2013;8(3): e60008.

    Article  Google Scholar 

  37. Unver S, Kavlak E, Gümüsel HK, Celikbilek F, Kirilmaz A. Correlation between hypervolemia, left ventricular hypertrophy and fibroblast growth factor 23 in hemodialysis patients. Ren Fail. 2015;37(6):951–6.

    Article  CAS  PubMed  Google Scholar 

  38. Park WY, Park S, Kim YW, Jin K. Clinical efficacy of biomarkers for evaluation of volume status in dialysis patients. Medicine. 2020;99(31): e21460.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Ozkahya M, Toz H, Qzerkan F, Duman S, Ok E, Basci A, Mees EJ. Impact of volume control on left ventricular hypertrophy in dialysis patients. J Nephrol. 2002;15(6):655–60.

    PubMed  Google Scholar 

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Acknowledgements

We appreciate the support of our colleagues from the Department of Blood Purification, General Hospital of Northern Theater Command.

Funding

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Author notes

  1. Jiuxu Bai and Wanqing Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Blood Purification, General Hospital of Northern Theater Command, 83 Wen Hua Road, Shenyang, 110016, Liaoning, China

    Jiuxu Bai, Wanqing Huang, Yanping Zhang, Lin Wei, Chen Zhao, Zhuo Ren, Qian Wang, Kaiming Ren & Ning Cao

  2. Postgraduate Training Base of Jinzhou Medical University (General Hospital of Northern Theater Command), Jinzhou, China

    Wanqing Huang

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  1. Jiuxu Bai
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Contributions

JXB and NC conceived the study and its design, had full access to the patient records, and take responsibility for the accuracy and integrity of the data. JXB and WQH contributed to the analysis and interpretation of the data. YPZ, LW, CZ, ZR, QW and KMR participated in patient inclusion and demographic data collection. The manuscript was drafted and written by JXB and WQH. All the authors critically revised the drafted manuscript. The authors have read and approved the final manuscript.

Corresponding author

Correspondence to Ning Cao.

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Conflict of interest

The authors declare that there are no conflicts of interest.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of the General Hospital of Northern Theater Command (approval number Y (2023) 115).

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The requirement to obtain written informed consent from each patient was waived because this was an observational retrospective study.

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Bai, J., Huang, W., Zhang, Y. et al. Left ventricular hypertrophy and left atrial diameter are associated with mortality risk in haemodialysis patients: a retrospective cohort study. Clin Exp Nephrol (2024). https://doi.org/10.1007/s10157-024-02480-z

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