Original InvestigationLeft ventricular mass index increase in early renal disease: Impact of decline in hemoglobin★
Section snippets
Patients and methods
This Canadian multicenter prospective cohort study enrolled 446 patients with renal insufficiency. Consecutive patients seen by nephrologists in eight academic centers were enrolled onto the study if they met eligibility criteria. Eligible patients were those who had impaired renal function, defined as calculated creatinine clearance (using the Gault-Cockroft formula14) between 25 and 75 mL/min; clinically established chronicity by biopsy or clinical course; and/or renal ultrasound showing
Demographics
Of the 446 patients enrolled, 318 (71% of the original cohort) completed 12 months of follow-up. Of the remaining 128 patients without a 12-month follow-up, 43 patients were lost or refused further follow-up, 45 patients started dialysis, 17 patients died, 1 patient received a transplant, and 22 patients had protocol deviations consisting of collection of follow-up data outside the 3 month grace period (ie, >15 months or <9 months).
Two assessable echocardiograms were available in 246 of the 318
Discussion
This large, multicenter, cohort study shows that patients with mild to moderately impaired renal function who do not have arteriovenous fistulae and are not yet undergoing dialysis have a high prevalence of LVH early in the course of their renal disease. Furthermore, a substantial proportion of the cohort show a significant increase in LVMI. LVG occurs in association with potentially modifiable risk factors; decrease in Hgb level and increase in systolic blood pressure.
This study extends
Acknowledgements
Acknowledgment: The authors thank the Kidney Foundation of Canada for grant support for this study, the many research nurses across the country who helped in data collection and validation, and the expert technical support of the cardiac sonographers, especially Roz Gillis.
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Received February 20, 1998; accepted in revised form December 18, 1998.
Supported in part by a grant from the Kidney Foundation of Canada, Montreal, Canada, 1994-1998 (A.L., C.R.T., and J.S.).
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Address reprint requests to Adeera Levin, MD, Director, Renal Insufficiency Clinic, St Paul's Hospital, Room 6010 A Providence Wing, 1081 Burrard St, Vancouver BC, V6Z 1Y8, Canada. E-mail: [email protected]