Clinical correlates and mortality impact of left ventricular hypertrophy among new ESRD patients in the United States

Background: Left ventricular hypertrophy (LVH) is common among patients with end-stage renal disease (ESRD), but few population-based studies exist. Here, we describe clinical correlations and mortality impact of LVH in new patients with ESRD from the Dialysis Morbidity and Mortality Study Wave 2. Methods: Echocardiographic data denoting the presence or absence of LVH were available for 64% (n = 2,584) of the entire cohort. Multivariate logistic regression identified significant correlates of LVH, and Cox proportional hazards regression estimated the mortality risk (risk ratio [RR]) for LVH at 6, 12, and 24 months. Results: The prevalence of LVH was 16.4%. Multivariate analysis identified age (adjusted odds ratio [OR], 1.15 per 10 years older), hypertension (OR, 1.39), diabetes (OR, 1.47), tobacco use (OR, 1.42), serum calcium level (OR, 1.17 per 1 mg/dL [0.25 mmol/L] higher), parathyroid hormone level greater than versus less than 157 pg/mL (157 ng/L; OR, 1.53), serum albumin level (OR, 1.38 per 1 g/dL [10 g/L] lower), and presence of pericarditis (OR, 2.55) as significant disease correlates. The impact of LVH on subsequent mortality was greatest in the first 6 months of follow-up (RR, 1.61; confidence interval [CI], 1.17 to 2.22) and became less pronounced thereafter (RR, 1.36; Cl, 1.07 to 1.89; RR, 1.29; Cl, 1.07 to 1.56 at the end of 1 and 2 years, respectively). Conclusion: This study identifies known coronary risk factors and markers of uremia as independent correlates of LVH presence in new patients with ESRD. It also highlights the adverse impact of pre-ESRD LVH on short-term patient survival. Given the clinical consequences of LVH on morbidity and mortality, greater efforts are required to reduce known risk factors for LVH in the pre-ESRD period.