HYPERTROPHIE VENTRICULAIRE GAUCHE AU COURS DE L’INSUFFISANCE RENALE CHRONIQUE : PREVALENCE ET FACTEURS DE RISQUE

Abstract

Introduction Cardiovascular disease represents the main cause of death of the patients affected by chronic kidney disease. In uremic subject, left ventricular hypertrophy (LVH) is the early morphological abnormality can leading to chronic heart failure. Objectives The aim of this work is to determine the prevalence of LVH in various stages of chronic kidney disease, to identify the associated risk factors and to estimate prevalence of diastolic dysfunction Patients and methods The study is transverse descriptive (January 2008 at June 2012).244 patients are included, 15 to 75 years old, suffering from CKD, stages 2 to 5 (including dialyzed patients).The recruited patients have conservative treatment. Left ventricular mass was evaluated by echocardiography; the LVH was defined by LVMI (LVM/surface body), higher than 115 g/m2 in men and higher than 95g/m2 in women. Diastolic function was evaluated by estimates of left ventricular filling pressures Natriuretic peptide (NT-Pro BNP) was measured by immunochimiluminescence Data were analyzed using software SPSS Version 19 Results The mean age of patients is 53, 2 years; sex ratio is 0, 95; hypertensive, diabetic and anemic patients are 69, 3%, 28, 3% and 48% of cases respectively. Prevalence of LVH is 59, 8%. It is significantly present at early stages of CKD (25%), and increases with decline of renal function to reach 82% in dialyzed patients. It is of mixed type, concentric (39%) and eccentric (43%), and except for age, is related to modifiable factors: systolic hypertension, hyperparathyroidism, diabetes and decline of GFR. Quarter of patients has high left ventricular filling pressures; among them 88, 5% have associated LVH. Rise of left ventricular filling pressures is correlated with age, systolic hypertension, LVH and deterioration of renal function. NT-ProBNP is a useful marker of LVH and diastolic dysfunction; however its thresholds remain to be redefined in CKD. Conclusion Presence of LVH places the uremic patient in high-risk cardiovascular category. Its prevention includes detection and early correction of cardiovascular risk factors - specific or not- of the uremic state. Key words: Chronic renal failure, left ventricular hypertrophy, diastolic dysfunction, hypertension, anemia, hyperparathyroidism, NT pro-BNP