Relationship between left ventricular hypertrophy and plasma renin activity in chronic hemodialysis patients

• Published in: Journal of the American Society of Nephrology Vol. 8; no. 11; pp. 1764 - 1770
• Main Authors: VLAHAKOS, D. V, HAHALIS, G, VASSILAKOS, P, MARATHIAS, K. P, GEROULANOS, S
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-11-1997
• Subjects: Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cross-Sectional Studies; Echocardiography; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - enzymology; Hypertrophy, Left Ventricular - etiology; Intensive care medicine; Kidney Failure, Chronic - therapy; Linear Models; Male; Medical sciences; Middle Aged; Renal Dialysis - adverse effects; Renin - blood; Sensitivity and Specificity; Human; Cell proliferation; Correlation; Pathophysiology; Enzyme; Hemodialysis; Cardiovascular disease; Left ventricle; Myocyte; Extrarenal dialysis; Peptidases; Chronic; Renin; Heart disease; Hydrolases; Aspartic endopeptidases; Angiotensin II; Fibroblast; Quantitative analysis; Hypertrophy
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/ASN.V8111764

Left ventricular hypertrophy (LVH) is very common in uremic patients. It was shown previously that hemodialysis patients are chronically exposed to the extremes of plasma renin activity due to differences in the original renal disease. Because nonhemodynamic factors seem to play a fundamental role in the development of LVH, the present study was undertaken to investigate the relationship between the predialysis renin level and the echocardiographically determined cardiac structure in stable hemodialysis patients, matched for other parameters known to participate in the development of LVH, such as age; gender; body mass index; interdialytic weight gain; heart rate; systolic, diastolic, and mean arterial BP; hematologic and biochemical profile; vascular access; adequacy of dialysis; nutritional status; and period of follow-up. Thirty-three such patients were stratified in three groups according to predialysis renin levels: group A (n = 11), with renin levels < or = 1 ng.ml-1.h-1; group B (n = 9), with renin levels between 1 and 4 ng.ml-1.h-1; and group C (n = 13), with renin levels > or = 4 ng.ml-1.h-1. LVH with disproportionate septal thickening was directly related to the degree of renin-angiotensin system activation, and values for interventricular septum thickness, posterior wall thickness, interventricular septum thickness/posterior wall thickness ratio, left ventricular mass, and left ventricular mass index were all significantly correlated with predialysis renin levels. Because angiotensin II promotes growth in both fibroblasts and cardiac myocytes, these relationships suggest that elevated renin levels may be causally associated with the development of LVH in chronic hemodialysis patients.