The Risk Factors Of Left Ventricular Hypertrophy And The Role Of Hemoglobin Acquired Target In Maintenance Hemodialysis Patients

Objective To investigate the incidence and risk factors of LVH in maintenance hemodialysis(MHD) patients and evaluate the diagnostic value of three electrocardiographic methods which are commonly used for left ventricular hypertrophy(LVH).To investigate the effect of anemia correction on reversing left ventricular hypertrophy in maintenance hemodialysis patients.Methods 224 patients who underwent maintenance hemodialysis were enrolled in this study.Their baseline anthropometric and laboratory parameters were collected,and ultraechocardiography and electrocardiogram were performed to diagnose LVH.These patients were divided into LVH group(183 cases)and non LVH group(41cases).The clinical data of the two groups were analyzed with single factor analysis and Logistic multivariate regression analysis to identify factors that affect the incidence of LVH in MHD patients.According to the level of hemoglobin,LVH group were divided into anemia group and non-anemia group.Both groups took ultraechocardiography at the end of a 6 months follow-up. During the follow- up,blood pressure was kept in good control in both groups, there was no change of patients’ dialysis regime.Patients in anemia group had an improvement on hemoglobin level after drug( including erythropoietin and intravenous iron sucrose) adjustment while patients in non-anemia group kept a steady hemoglobin level during the 6 months.Results In the 224 MHD patients,LVH was found in 183(81.7%) patients. By using electrocardiogram to assess LVH of these patients,among Chinese criteria,Cornall criteria and 2013 ESC criteria, the most sensitive one was 2013 ESC criteria(37.16%)and the most specific one was Chinese criteria(88.80%).Systemic pressure,female,Interdialytic weight gain(IDWG)and patients with diabetes were higher in LVH group as compared to non LVH group,while Hb, patients using Angi- otension converting enzyme inhibitors/Angiotensin receptor blockers(ACEI /ARB) and Urea reduction ratio(URR) were lower(P<0.05).Multivariate logistic regression analysis revealed that the independent factors for LVH were female,with diabetes, without using ACEI/ARB,higher systemic pressure,lower hemoglobin and higher IDWG.There are 118 patients whose hemoglobin level<110g/L in LVH group. After6 months follow-up,50 patients in anemia group had an improvement on hemoglobin(115.7±9.20) g/L while 62 patients remained hemoglobin level<110g/L. UCG showed LVM, IVST and LVPWT of anemia-corrected patients significantly decreased.As for the hemoglobin-acquired-target group, there was no significant change on LVMI after6 months follow-up.Conclusion The incidence of LVH is high, and is closely related to gender,hemoglobin level,diabetes,systemic pressure,IDWG and using ACEI/ARB in MHD patients. Therefore,early preventive treatment should be given to patients with those clinical features so as to improve outcomes. Furthermore,electrocardiogram could be taken periodically in order to observe LVH in MHD patients early.Anemia is one of the independent factors for LVH in MHD patients,and the remission of the LVH may benefits from hemoglobin acquiring target.