Structural and functional condition of the myocardium and the relationship of metabolic disorders in patients with chronic kidney disease

Abstract

Purpose. Study of the structural and functional characteristics of the heart in patients receiving long term hemodialysis (HD) treatment, and the identification of links with bone mineral, lipid disorders and anemia.Material and methods. A total of 160 patients with chronic kidney disease (CKD) of the 5th dialysis (5D) stage (70 men, 90 women) who were treated in the hemodialysis departments of Izhevsk were examined. The average age of patients is 52.9 ± 2.0 years old (31 to 78 years old). The procedures were performed 3 times a week for 4–4.5 hours. The inclusion criteria were the duration of dialysis therapy for at least one year and the availability of informed consent. The adequacy index Kt / V amounted to1.56 ± 0.2. Echocardiographic examination assessed the structural and functional parameters, calculated Left Ventricular Mass, LVM index, relative thickness index, “inner membrane”, fractional-shortening of the middle fibers. A study of general clinical indicators of mineral-bone disorders, Lipemic index, erythrocytes was carried out.Results. Violation of left ventricular (LV) geometry was found in 140 (87.5%) patients with 5D CKD stage. Concentric and eccentric hypertrophy prevailed. No significant dependence on patient’s sex was revealed. Patients with eccentric hypertrophy showed high rates of inter-dialysis weight gain (p < 0.05) and ultrafiltration (p < 0.05). In patients with concentric hypertrophy, high indicators of calcium-phosphorus metabolism (p < 0.05), pre-dialysis systolic pressure (p < 0.05) and pulsatility (p < 0.05) were obtained. They also tended to have higher triglyceride indices and more pronounced anemia. The correlation of the structural and functional state of the myocardium with the level of phosphorus, calcium, calcium-phosphorus ratio and pulsatility was established.Conclusions. In most patients with stage 5D CKD, LV remodeling with the prevalence of concentric and eccentric hypertrophy is observed. No significant gender differences were found. In patients with hypervolemia requiring more intense ultrafiltration during dialysis, eccentric LV hypertrophy was detected. High values of pre-dialysis and pulsatility, as well as levels of calcium and phosphorus, are observed with the concentric remodeling type. Correlations of structural changes in the myocardium with calcium-phosphorus metabolism were revealed. The data obtained may open new ways of influencing the regression of LV hypertrophy and improve the cardiovascular prognosis in patients receiving programmed hemodialysis treatment.