scholarly journals Left ventricular mass regression, all-cause and cardiovascular mortality in chronic kidney disease: a meta-analysis

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Kevin C. Maki ◽  
Meredith L. Wilcox ◽  
Mary R. Dicklin ◽  
Rahul Kakkar ◽  
Michael H. Davidson

Abstract Background Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. Methods The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. Results The meta-analysis included 42 trials with duration ≥12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 12 of other types of interventions. All-cause mortality was reported in 121/2584 (4.86%) subjects in intervention groups and 168/2606 (6.45%) subjects in control groups. The pooled RR estimate of the 27 trials ≥12 months with ≥1 event in ≥1 group was 0.72 (95% CI 0.57 to 0.90, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥6 months (34 trials), ≥9 months (29 trials), and >12 months (10 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.67, 95% CI 0.39 to 1.16. Conclusions These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.

2021 ◽  
Author(s):  
Kevin C. Maki ◽  
Meredith L. Wilcox ◽  
Mary R. Dicklin ◽  
Rahul Kakkar ◽  
Michael H. Davidson

Abstract Background Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. Methods The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥ 12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. Results The meta-analysis included 38 trials with duration ≥ 12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 8 of other types of interventions. All-cause mortality was reported in 116/2385 (4.86%) subjects in intervention groups and 161/2404 (6.70%) subjects in control groups. The pooled RR estimate of the 24 trials ≥ 12 months with ≥ 1 event in ≥ 1 group was 0.72 (95% CI 0.57 to 0.91, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥ 6 months (31 trials), ≥ 9 months (26 trials), and > 12 months (9 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.66, 95% CI 0.38 to 1.15. Conclusions These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.


2016 ◽  
Vol 15 (2) ◽  
pp. 207-215
Author(s):  
Kiran Kumar Singal ◽  
Neerja Singal ◽  
Parveen Gupta ◽  
Jagdish Chander ◽  
Pankaj Relan

Background: Chronic Renal Insufficiency is a major public health problem. Cardiovascular Disease is the leading cause of morbidity and mortality in patients at every stage of Chronic Kidney Disease. There is a 10-200 fold increased risk of cardiovascular disease in those with Chronic Kidney Disease compared to the age and sex matched with general population, depending on the stage of Chronic Kidney Disease. Objective: The objective of the study was to see correlation, if any, of cardiac status and stage of kidney disease. Materials and methods: The study was conducted at M. M. Institute of Medical Sciences and Research, Mullana, Ambala. Thirty patients of Chronic Kidney Disease were included in the study. Chronic Kidney Disease is defined as kidney damage lasting for more than 3 months characterised by structural or functional abnormalities of the kidney, with or without decreased Glomerular Filtration Rate (GFR), according to the K/DOQI Guidelines. Inclusion criteria were based on symptomatology and clinical history of features suggestive of Chronic Kidney Disease. Symptoms, Signs and history of the patients were used to filter out patients who did not fit in the criteria and selected patients on the basis of criteria were further evaluated and investigated. All patients were subjected to detailed history and clinical examination. Patients with age <20 years, with history of Diabetes Mellitus, Dyslipidemia, Intrinsic Diseases of Ventricles, Congenital Heart Disease and chronic smokers were excluded from the study. A standard 12 lead ECG was done in all cases. Echocardiography was done in ECHO lab of Cardiology unit in MMIMSR. Echocardiographic assessment was done by using Model vivid Colour Doppler Echocardiography machine of GE make. Apical four chamber view was employed to obtain the measurements of Left ventricular volume in diastole and systole, Ejection fraction; Left Ventricular Indices were assessed and then were used to calculate Left Ventricular Mass by using the cube formula proposed by Devereux. Patients included in the study were treated as per the standard treatment schedule. The data obtained was analysed with appropriate statistical analysis tools at the end of the study and conclusive evidence was derived. Results: In the present study the mean Left Ventricular Mass was 249.76 ± 69.35 gms with 73% study cases having Left Ventricular Mass more than the reference range, also Left Ventricular Mass showed a progressive rise with increase in S. Creatinine levels. In the present study, Left Ventricular dysfunction was seen in nearly half of the cases while approximately one-fourth cases (23%) also had Systolic Dysfunction. Pericardial Effusion was also observed in 10 % the study cases in the present study.Conclusion: Cardiac functions particularly Left Ventricular parameters. Left Ventricular free wall thickness and Left Ventricular Mass being common abnormality in CKD patients.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.207-215


2011 ◽  
Vol 29 (3) ◽  
pp. 565-573 ◽  
Author(s):  
Giovanni Cioffi ◽  
Luigi Tarantini ◽  
Roberto Frizzi ◽  
Carlo Stefenelli ◽  
Tiziano E Russo ◽  
...  

2019 ◽  
Vol 44 (4) ◽  
pp. 690-703 ◽  
Author(s):  
Laura Jahn ◽  
Rafael Kramann ◽  
Nikolaus Marx ◽  
Jürgen Floege ◽  
Michael Becker ◽  
...  

Background and Objectives: Patients with chronic kidney disease (CKD) exhibit a highly increased risk of cardiovascular (CV) morbidity and mortality. Subtle changes in left ventricular function can be detected by two-dimensional (2D) speckle tracking echocardiography (STE). This study investigated whether myocardial dysfunction detected by 2D STE may aid in CV and all-cause mortality risk assessment in patients with CKD stages 3 and 4. Method: A study group of 285 patients (CKD 3: 193 patients; CKD 4: 92 patients) and a healthy control group (34 participants) were included in the retrospective study. 2D STE values as well as early and late diastolic strain rates were measured in ventricular longitudinal, circumferential and radial directions. Patients’ CV and all-cause outcome was determined. Results: In the CKD group all measured longitudinal STE values and radial strain were significantly reduced compared to the control group. Cox proportional hazards regression revealed global longitudinal strain to predict CV and all-cause mortality (hazard ratio [HR] 1.15, 95% CI 1.06–1.25; p = 0.0008 and HR 1.09, 95% CI 1.04–1.14; p = 0.0003). After adjustment for sex, age, diabetes, estimated glomerular filtration rate, and preexisting CV disease, this association was maintained for CV mortality and all-cause mortality (HR 1.16, 95% CI 1.06–1.27; p = 0.0019 and HR 1.08, 95% CI 1.03–1.14; p = 0.0026, respectively). Conclusions: The present study shows that 2D STE detects reduced left ventricular myocardial function and allows the prediction of CV and all-cause mortality in patients at CKD stages 3 and 4.


2009 ◽  
Vol 4 (Supplement 1) ◽  
pp. S79-S91 ◽  
Author(s):  
Richard J. Glassock ◽  
Roberto Pecoits-Filho ◽  
Silvio H. Barberato

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