Hypertension and left ventricular hypertrophy in patients with predialysis CKD stages and on renal replacement therapy

Cardiovascular comorbidity is an important determinant of outcome of CKD treatment. However the incidence, prevalence and changes over time in cardiac remodeling differ among various populations, at different stages of CKD and vary with renal replacement therapy (RRT) modality. Determination of influencing factors could prevent undesirable progression of the remodeling as well as will help to choose appropriate time and RRT modality in the context of the integrated care. Echocardiographic finding in 96 predialysis, hemodialysis and peritoneal dialysis patients including repeated examinations during one year revealed the prevalence and structure of the cardiac remodeling, its relationship with arterial hypertension, calcium-phosphate disorders, anemia, malnutrition-inflammation syndrome, achieving of volume balance. Usually these relationships are non-linear and this hampers their determination. Moreover, many influencing factors are closely related. Patients with PTH level within target range 150–300 pg/ml demonstrated positive changes in remodeling in repeated examinations compared to patients with lower and higher values. Patients whose hemoglobin often falls below 95 g/l often showed negative changes over time. Due to increased prevalence of the left ventricular hypertrophy among patients on PD in spite of lower degree of arterial hypertension they require more attention during maintaining volume balance and use of peritoneal solutions with glucose polymer.

хроническая болезнь почек, артериальная гипертония, гипертрофия левого желудочка, ремоделирование миокарда, факторы риска

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