Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs

Background. Left ventricular hypertrophy (LVH) is very frequent in haemodialysis patients. Only few investigations have reported its regression, and only by the use of antihypertensive drugs. Because volume load is at least as important as pressure load, we investigated whether persistent strict volume control by ultrafiltration alone may be effective in improving LVH Methods. Using blood pressure (BP) and cardiac dimensions as a guide, we treated all hypertensive patients in our dialysis unit during the 3 times weekly dialysis sessions for 4 h per session with as much ultrafiltration as they could stand. If they gained too much weight an extra isolated ultrafiltration (UF) session was applied. Special attention was given to dietary salt restriction. The study group of all 15 patients in whom echocardiographic assessment had been made at least 1.5 years previously was selected retrospectively, and we acknowledge that important confounding factors might not have been controlled for. Cardiothoracic index (CTI) was estimated on the chest X-ray. Diameters of left atrium (LA), left ventricle systolic (LVS) and diastolic (LVD), interventricular septum (IVS), posterior wall (PW), and left ventricular mass index (LVMI) were estimated by standard echocardiographic methods. Results. Mean arterial pressure of the study group had been lowered by UF before the first echocardiogram from predialysis 136 +/- 11 to 101 +/- 14 and from postdialysis 119 +/- 8 to 92 +/- 12 mmHg. During a mean follow-up period of 37 +/- 11 months LVMI decreased from 175 +/- 60 to 105 +/- 11 g/m(2). CTI decreased further from 48 +/- 3 to 43 +/- 4%, while significant decreases of LA (22.5 +/- 3 to 19.9 +/- 4 mm/m(2)), LVS (18.7 +/- 4 to 15.9 +/- 3 mm/m(2)) and LVD (28.3 +/- 4 to 24.0 +/- 3 mm/m(2)) were seen in all patients. There also was a further decrease in both pre-and postdialysis BP to 116 +/- 12/73 +/- 7 and 105 +/- 7/65 +/- 3 mmHg respectively. Conclusion. The results of this uncontrolled retrospective study suggest that good long-term BP control and a decrease of LVM can be achieved by continuous efforts to control hypervolaemia. The decrease in volume may be even more important than pressure reduction to achieve this goal.