Prognostic significance of left ventricular hypertrophy observed at dialysis initiation depends on the pre-dialysis use of erythropoiesis-stimulating agents.
Prognostic significance of left ventricular hypertrophy observed at dialysis initiation depends on the pre-dialysis use of erythropoiesis-stimulating agents.
复制标题
透析开始时观察到的左心室肥大的预后意义取决于透析前红细胞生成刺激剂的使用。
DOI：
10.1007/s10157-012-0705-4
复制
发表时间：
2012
期刊：
影响因子：
2.3
通讯作者：
Hayashi T
中科院分区：
文献类型：
--
作者：
藤原 一志郎;長谷川 孝一;吉川 和明;Hayashi T
背景最近的实验研究表明，促红细胞生成素在左心室肥厚 (LVH) 期间可促进有益的心肌重塑。然而，由于慢性肾病患者的促红细胞生成素生成不足，这种代偿能力可能会受到限制。因此，本研究旨在探讨透析前红细胞生成刺激剂 (ESA) 使用对透析患者 LVH 预后意义的影响。 方法 这项回顾性研究包括 2001 年至 2009 年间开始透析的 404 名连续患者。 2010 年使用 Cox 模型。结果在中位随访 36.5 个月期间，164 名患者死亡，其中 31 人死于心力衰竭。透析前 ESA 使用频率为 58.7%，中位 LVMI 为 160.3 g/m2。有趣的是，LVMI 最低三分位数的患者与后续各三分位数的患者相比，生存率更差。经过包括射血分数在内的广泛调整后，LVMI 与全因死亡率呈负相关[风险比 (HR) 0.991，95% 置信区间 (CI) 0.988–0.995，P=0.000]，而 LVMI 对心血管死亡率的预后价值取决于透析前 ESA 的使用[调整后的 HR 1.010，95% CI]透析前 ESA(+) 为 0.999–1.020，P= 0.065，透析前 ESA(−) 为 0.978，95% CI 0.967–0.989，P= 0.000]。结论我们的结果表明 LVH 和死亡率之间可能存在相反的流行病学关系，并且透析前 ESA 的使用可能会改变透析开始时观察 LVH 与透析患者心血管死亡率的关系。
BackgroundRecent experimental studies suggest that erythropoietin promotes beneficial myocardial remodeling during left ventricular hypertrophy (LVH); however, such compensatory capacity may be limited due to insufficient erythropoietin production in chronic kidney disease patients. Thus, this study aimed to explore the effect of pre-dialysis erythropoiesis-stimulating agent (ESA) use on the prognostic significance of LVH in dialyzed patients.MethodsThis retrospective study included 404 consecutive patients who started dialysis between 2001 and 2009. The interaction of ESA with the association between left ventricular mass index (LVMI) observed at dialysis initiation and all-cause and cardiovascular mortality was analyzed at the end of 2010 using the Cox model.ResultsDuring a median follow-up of 36.5 months, 164 patients died, 31 of them from heart failure. The frequency of pre-dialysis ESA use was 58.7 % and median LVMI was 160.3 g/m2. Of interest, patients with the lowest tertile of LVMI had worse survival compared with those with each subsequent tertile. LVMI was inversely associated with all-cause mortality [hazard ratio (HR) 0.991, 95 % confidence interval (CI) 0.988–0.995,P= 0.000] after extensive adjustment including ejection fraction, whereas the prognostic value of LVMI for cardiovascular mortality was dependent on pre-dialysis ESA use [adjusted HR 1.010, 95 % CI 0.999–1.020,P= 0.065 for pre-dialysis ESA(+) and 0.978, 95 % CI 0.967–0.989,P= 0.000 for pre-dialysis ESA(−), respectively].ConclusionsOur results suggest that reverse epidemiology may exist between LVH and mortality and that pre-dialysis ESA use may modify the prognostic significance of LVH observed at dialysis initiation for cardiovascular mortality in dialyzed patients.