Department of Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey.
Am Heart J. 2010 Jun;159(6):1089-94. doi: 10.1016/j.ahj.2010.03.020.
Echocardiography provides insight to the management of end-stage renal disease (ESRD) and might be valuable in assessing the prognosis. We evaluated the predictive value of echocardiography along with clinical findings in a low-risk hemodialysis (HD) population who had been treated with strict salt restriction strategy for blood pressure control.
Study population consisted of a cohort of 555 ESRD patients from 8 HD centers where the same strict volume control strategy applied for blood pressure control. Clinical findings and echocardiography were examined as predictors of mortality for a mean follow-up period of 3 years (29.6 +/- 11.6 months).
During the follow-up, 89 patients (16%) died. Left atrium (LA) volume index was the only independent echocardiographic predictor of mortality (hazard ratio 1.025, 95% CI 1.001-1.050, P = .042). The other predictors of mortality were age, pulse pressure, diabetes mellitus, and high-sensitivity C-reactive protein. However, when we added interdialytic weight gain (IDWG) ratio to the Cox model, it also appeared as an independent predictor of mortality, whereas LA volume index no longer was.
Increased LA volume index emerged as the only independent echocardiographic determinant of mortality in low-risk dialysis patients treated by strict volume control. Close relationship with IDWG ratio indicates the intermittent stretching of atrium between dialysis sessions leading to atrial remodeling. This index is not the result of a single factor such as age, hypervolemia, or left ventricular hypertrophy but reflects the combination of these contributing causes. Therefore, it might be considered as an overall echocardiographic sign of mortality in ESRD.
超声心动图为终末期肾病（ESRD）的管理提供了深入了解，并且在评估预后方面可能具有价值。我们评估了超声心动图与临床发现在接受严格盐限制策略治疗以控制血压的低风险血液透析（HD）人群中的预测价值。
研究人群由 8 个 HD 中心的 555 名 ESRD 患者组成，这些中心均应用相同的严格容量控制策略来控制血压。在平均 3 年（29.6 +/- 11.6 个月）的随访期间，检查了临床发现和超声心动图作为死亡率的预测指标。
在随访期间，89 名患者（16%）死亡。左心房（LA）容积指数是唯一独立的超声心动图死亡率预测指标（危险比 1.025，95%CI 1.001-1.050，P =.042）。死亡率的其他预测因素是年龄、脉压、糖尿病和高敏 C 反应蛋白。然而，当我们将透析间体重增加（IDWG）比值添加到 Cox 模型中时，它也成为死亡率的独立预测因素，而 LA 容积指数不再是。
在接受严格容量控制治疗的低风险透析患者中，LA 容积指数增加是死亡率的唯一独立超声心动图决定因素。与 IDWG 比值的密切关系表明，在透析之间心房会间歇性伸展，导致心房重构。该指数不是年龄、血容量过多或左心室肥厚等单一因素的结果，而是反映了这些促成因素的组合。因此，它可能被视为 ESRD 死亡率的整体超声心动图标志。
