Elderly LVH Patients Experience Rapid Kidney Function Decline

Left ventricular hypertrophy is associated with a 4.5 times increased risk of rapid kidney function decline.
Left ventricular hypertrophy is associated with a 4.5 times increased risk of rapid kidney function decline.

Left ventricular hypertrophy (LVH) in seniors is associated not only with kidney function decline but an increased risk of rapid decline, researchers find.

Investigators examined data from 300 Chinese patients without end-stage renal disease (251 with LVH and 49 without) seen at Beijing Friendship Hospital from 2000 to 2010. The patients had a mean age of 80 years.

According to results published in the Journal of the American Heart Association, LVH patients had a higher risk of rapid kidney function decline compared with those without LVH. Researchers defined rapid decline as a drop in estimated glomerular filtration rate (eGFR) of 5 mL/min/1.73m2 or more over 12 months. In multivariable analysis, LVH patients had a statistically significant 4.5 times increased risk of rapid kidney function decline compared with the non-LVH patients.

At baseline, left ventricular mass index (LVMI) also differed significantly by eGFR: 140 g/m2 in the group without chronic kidney disease (CKD), 152 g/m2 in the mild CKD group (eGFR 60 mL/min/1.73m2 and above), and 153 g/m2 in the group with moderate to severe CKD (eGFR below 60 mL/min/1.73m2).

“Our study showed that moderate renal function injury tended to be associated with a higher LVMI, even though the blood pressure levels of the patients in our study were within the normal range,” the investigators stated. Blood pressure and ejection rate did not differ significantly between groups.

The researchers offered several potential explanations for how LVH accelerates renal function decline. First, hypertension exerts well-known effects on the kidney. LVH also can lead to left ventricular dysfunction and decrease perfusion in the glomeruli causing renal tubular ischemia. Third, inflammation may spur systolic dysfunction and cause faster CKD progression.

In accordance with previous research, lower baseline eGFR was found to be a risk factor for rapid decline in renal function. Other factors associated with a faster rate of decline included blood urea nitrogen and lower hemoglobin level. The researchers acknowledged they were unable to account for any effects of medications or gender (82% of patients were male).

In light of these findings, the investigators believe “regression of LVH may serve not only to decrease cardiovascular mortality but also to maintain renal function.”

Source

  1. Shi HT, Wang XJ, Li J, et al. Association of Left Ventricular Hypertrophy With a Faster Rate of Renal Function Decline in Elderly Patients With Non-End-Stage Renal Disease. J Am Heart Assoc. 2015;4:e002213; doi: 10.1161/JAHA.115.002213.
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