Published: 2019-04-26

A study on the left ventricular hypertrophy among the patients of chronic kidney disease stage third to five

Ashok Vankayala, Kamal Lochan Behera, D. S. S. K. Raju, Suresh Babu Sayana


Background: In Chronic kidney Disease (CKD) a significant risk factor for mortality is Cardiovascular disease (CVD) and the most prevalent cardiovascular risk factor is left ventricular hypertrophy (LVH). Anemia, hypertension and volume overload are risk factors for LVH in CKD. So, the present was aimed at comparing the risk factors between CKD with and without LVH.

Methods: A cross sectional study carried out over a 2 year period in Department Nephrology and General Medicine OPD, MIMS, Vizianagaram, Andhra Pradesh. A total of 120 patients are included in this study and divided in to CKD stage III to V based on estimated GFR. Based on 2D echocardiography data CKD cases are further divided in to CKD with LVH and CKD without LVH.

Results: The Left ventricular mass index was significant higher in CKD with LVH (128.89±19.28) when compared with CKD without LVH (108.20±10.28). The left ventricular mass index was noted in more number in stage V of CKD. It is also observed that the left ventricular mass index was negatively correlated with haemoglobin and eGFR and was positively correlated with systolic blood pressure and serum NT-proBNP.

Conclusions: Present study finding suggested that the incidence of LVH is higher in CKD patients. LVH was positively correlated with hypertension and NT-proBNP and negatively correlated with anemia and estimated GFR.


Chronic kidney disease, Cardio vascular disease, Left ventricular hypertrophy, 2D echocardiography

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Singh AK, Farag YM, Mittal BV, Subramanian KK, Reddy SR, Acharya VN, et al. Epidemiology and risk factors of chronic kidney disease in India-results from the SEEK (Screening and Early Evaluation of Kidney Disease) study. BMC Nephrology. 2013;14(1):114.

Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, et al. Chronic kidney disease and mortality risk: a systematic review. J Am Society Nephrol. 2006 Jul 1;17(7):2034-47.

Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension. 2003;42:1050-65.

Muntner P, He J, Astor BC, Folsom AR, Coresh J. Traditional and non-traditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol. 2005;16(2):529-38.

Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, Barre PE. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney International. 1995 Jan 1;47(1):186-92.

Port FK, Hulbert-Shearon TE, Wolfe RA, Bloembergen WE, Golper TA, Agodoa LY, et al. Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. Am J Kidney Dis. 1999;33(3):507-17.

Ferrari P, Mallon D, Trinder D, Olynyk JK. Pentoxifylline improves haemoglobin and interleukin‐6 levels in chronic kidney disease. Nephrol. 2010;15(3):344-9.

Datta S, Abraham G, Mathew M, Somasundaram H, Muralidharan TR. Correlation of anemia, secondary hyperparathyroidism with left ventricular hypertrophy in chronic kidney disease patients. JAPI. 2006;54:699-703.

Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, Barre PE. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney international. 1995;47(1):186-92.

Satyan S, Light RP, Agarwal R. Relationships of N-terminal pro-B-natriuretic peptide and cardiac troponin T to left ventricular mass and function and mortality in asymptomatic hemodialysis patients. American J Kidney Dis. 2007 Dec 1;50(6):1009-19.

Wang AY, Lam CW, Yu CM, Wang M, Chan IH, Zhang Y, et al. N-terminal pro-brain natriuretic peptide: an independent risk predictor of cardiovascular congestion, mortality, and adverse cardiovascular outcomes in chronic peritoneal dialysis patients. J American Society Nephrol. 2007 Jan 1;18(1):321-30.

Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis. 1996;27(3):347-54.

Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limbs leads. Am Heart J. 1949;37:161-86.

Krumholz HM, Larson M, Levy D. Prognosis of left ventricular geometric patterns in the Framingham heart study. J Am Coll Cardiol. 1995;25:879-84.

Tiffany TO. Jansen JM, Burtis CA, Overton JB, Scott CD. Clin. Chem. 1972;18:829.

Bowers LD, Wong ET. Kinetic serum creatinine assays. II. A critical evaluation and review. Clinical Chemistry. 1980;26(5):555-61.

Levey AS. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol. 2000;11:A0828.

Nielsen LS, Svanegaard J, Klitgaard NA, Egeblad H. N‐terminal pro‐brain natriuretic peptide for discriminating between cardiac and non‐cardiac dyspnoea. European journal of heart failure. 2004;6(1):63-70.

Madsen LH, Ladefoged S, Corell P, Schou M, Hildebrandt PR, Atar D. N-terminal pro brain natriuretic peptide predicts mortality in patients with end-stage renal disease in hemodialysis. Kidney international. 2007;71(6):548-54.

Kinnunen PA, Vuolteenaho OL, Ruskoaho HE. Mechanisms of atrial and brain natriuretic peptide release from rat ventricular myocardium: effect of stretching. Endocrinol. 1993 May 1;132(5):1961-70.

Holmes SJ, Espiner EA, Richards AM, Yandle TG, Frampton C. Renal, endocrine, and hemodynamic effects of human brain natriuretic peptide in normal man. J Clin Endocrinol Meta. 1993 Jan 1;76(1):91-6.

Vickery S, Price CP, John RI, Abbas NA, Webb MC, Kempson ME, et al. B-type natriuretic peptide (BNP) and amino-terminal proBNP in patients with CKD: relationship to renal function and left ventricular hypertrophy. Am J Kidney Dis. 2005;46(4):610-20.

Takami Y, Horio T, Iwashima Y, Takiuchi S, Kamide K, Yoshihara F, et al. Diagnostic and prognostic value of plasma brain natriuretic peptide in non-dialysis-dependent CRF. Am J Kidney Dis. 2004 Sep 1;44(3):420-8.

Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis. 1996 Mar 1;27(3):347-54.

Yilmaz BA, Mete T, Dincer I, Kutlay S, Sengül S, Keven K, Ertürk S. Predictors of left ventricular hypertrophy in patients with chronic kidney disease. Ren Fail. 2007;29:303-7.

Ulasi II, Arodiwe EB, Ijoma CK. Left ventricular hypertrophy in African Black patients with chronic renal failure at first evaluation. Ethnicity Disease. 2006 Sep 1;16(4):859.

Bregman R, Lemos C, Pecoits Filho R, Abensur H, Draibe S, Bastos MG, et al. Left ventricular hypertrophy in patients with chronic kidney disease under conservative treatment. Brazilian J Nephrol. 2010 Mar;32(1):85-90.