ABSTRACT
BACKGROUND: Calcification and dysfunction of aortic and mitral valves are frequently found in chronic dialysis patients, but their influence on the development of left ventricular hypertrophy (LVH) is not well defined. METHODS: Conventional echocardiography and Doppler measurement of trans-aortic flow velocity were performed in 135 chronic haemodialysis patients, and left ventricular mass index (LVMI) and trans-valve pressure gradients were calculated. Average values of systolic, diastolic and pulse pressure (PP), interdialytic weight gain, chronic overhydration (difference between mean post-dialysis and dry weights), plasma calcium, phosphate, haemoglobin, and urea reduction ratio over the year preceding this study were obtained in every patient. RESULTS: Aortic valve calcification was present in 105 patients (78%), associated with stenosis in eight (6%); 39 patients (29%) had aortic regurgitation. Mitral annular calcification occurred in 35 (26%) cases and mitral regurgitation in 45 (33%). LVH was observed in 104 patients (77%). Logistic analysis revealed that only aortic valve calcification predicted LVH. LVMI was higher in patients with aortic valve calcification than in those without calcification: (mean+/-SD) 241+/-52 vs 154+/-64 g/m(2), P=0.001. LVMI was not different between patients with normal, calcified, or regurgitating mitral valves. Patients with aortic valve calcification had higher trans-valve peak flow velocities and pressure gradients than those with non-calcified valves: 1.65+/-0.53 vs 1.37+/-0.33 m/s, P=0.01, and 12.1+/-8.9 vs 7.9+/-3.6 mmHg, P=0.01, respectively. The LVMI correlated directly with both variables (r=0.27 and r=0.24, P<0.005). Stepwise linear regression on nine covariates potentially influencing LVMI (age, body mass index, time on dialysis, systolic blood pressure, PP, chronic overhydration, haemoglobin concentration, trans-aortic flow velocity, and urea reduction ratio) showed that LVMI was independently associated with (i) PP, (ii) haemoglobin (inverse correlation), (iii) peak aortic flow velocity, and (iv) chronic overhydration (r=0.502, R(2)=0.252, ANOVA F-ratio=10.19, P<0.0005). CONCLUSION: Our findings show that aortic valve calcification is associated with LVH in chronic haemodialysis patients, probably because valve resistance to ventricular outflow is increased as shown by trans-aortic flow velocities and pressure gradients. The effect on LVMI is independent of PP, anaemia, and overhydration.
Subject(s)
Aortic Valve Stenosis/complications , Calcinosis/complications , Hypertrophy, Left Ventricular/etiology , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Renal Dialysis , Adolescent , Adult , Aged , Aged, 80 and over , Aorta/physiopathology , Aortic Valve Stenosis/physiopathology , Blood Flow Velocity , Blood Pressure , Calcinosis/physiopathology , Echocardiography , Female , Humans , Hypertrophy, Left Ventricular/diagnostic imaging , Male , Middle Aged , PulseSubject(s)
Pregnancy , Humans , Female , Hypertension , Pregnancy Complications , Anticonvulsants/administration & dosage , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/therapeutic use , Eclampsia , Hypertension/diagnosis , Hypertension/prevention & control , Hypertension/drug therapy , Hypertension/therapy , Maternal Mortality , Pre-EclampsiaSubject(s)
Adolescent , Adult , Middle Aged , Humans , Male , Female , Acidosis, Renal Tubular/physiopathology , Calcium/metabolism , Calcium/urine , Hyperparathyroidism/etiology , Medullary Sponge Kidney , Uric Acid/metabolism , Uric Acid/urine , Kidney Calculi/metabolism , Wounds and Injuries/complications , Cystinuria/complications , Enteritis/complications , Kidney Calculi/complications , Kidney Calculi/urineABSTRACT
El análisis de 59 pacientes con insuficiencia renal terminal sometidos a cirugía, permitió concluir que los pacientes urémicos en hemodiálisis crónica tienen una importante morbilidad postoperatoria en la que predominan la hemorragia, la infección, la hiperpotasemia y la sobrehidratación. Los factores preoperatorios que influyeron más claramente en el riesgo quirúrgico fueron la desnutrición y la infradiálisis. Un plan dialítico ajustado es la clave de la profilaxis, debiendo mantenerse en el perioperatorio sin que se distancien demasiado la hemodiálisis preoperatoria de la postoperatoria
