Left Ventricular Hypertrophy in Nondiabetics Patients with Predialysis Chronic Renal Disease in the Hospital Center Elbasan

Abstract

Background: Cardiovascular disease (CVD) is still the major cause of death in patients with end stage chronic kidney disease (ES-CKD), with a mortality rate approximately 10 to 30 times greater than that of the general population. Multiple factors are involved in the development of CVD in CKD. Although left ventricular hypertrophy (LVH) is strong predictor of mortality in patients with end-stage renal disease, few studies are available before the start of dialysis treatment in our country. The purpose of this study is to evaluate the prevalence and clinical correlates of LVH in nondiabetic patients with chronic kidney disease (CKD) not yet undergoing renal replacement therapy and to examine the relations between anemia, pulse pressure (PP), hypertension (HTA) with left ventricular hypertrophy (LVH). Materials and methods: We investigated 111 nondiabetic patients with CKD, presented in ambulatory service. Patients excluded from the study were of ischemic heart and valvular heart disease. 26 patients presented the second stage of CKD (GFR 60-89,9ml/min). 30 patients presented third stage of CKD (GFR 30–59,9ml/min).32 patients was at the 4th stage of CDK (GFR 15-29,9 ml /min) and 23 patients presented 5 the stage of CKD (GFR <15ml/min).Each patient had blood pressure (BP) measured by means of 24-hour ambulatory BP monitoring and left ventricular mass index (LVMi) assessed by means of M-mode echocardiography. Creatinine clearance was estimated by means of the Cockcroft-Gault formula, and hemoglobin was assessed by using routine methods. Results: The prevalence of LVH in nondiabetic predialysis patients with CKD was 81.9%; 22% of whom were women. The prevalence of hypertension was 72,6%. Anemia was present in all patients. In the overall group, prevalences of arterial hypertension, anemia and LVH were high. HTA is associated with LVH in patients with CKD, and the strong relationship between elevated pulse pressure and LVH in those with more advanced CKD suggests that increased arterial stiffness might have a role for LVH well before the start of dialysis therapy. Conclusions: In conclusion, the incidence of LVH was high even among nondiabetics patients under conservative treatment, and, except for age, LVH correlated with reversible factors. The need for strictly diagnosing CKD and preventing LVH in the predialysis phase is emphasized to decrease mortality due to CVD in that population.Keywords: Chronic Kidney Disease, Left ventricular hypertrophy; pulse pressure, hypertension, anemia