Aging and left ventricular mass and function in people with end-stage renal disease

Abstract

Objectives: To identify the main age-related factors responsible for cardiomyopathy in people with end-stage renal disease (ESRD).

Design: Cross-sectional.

Setting: Dialysis unit.

Participants: Two hundred fifty-four individuals undergoing chronic dialysis.

Measurements: Left ventricular (LV) systolic function (assessed according to midwall fractional shortening (mwFS)) and LV mass index (LVMI).

Results: At echocardiography, 196 (77%) participants displayed LV hypertrophy (LVH) and 123 (48%) had LV systolic dysfunction. On univariate analysis, age was related directly to LVMI (correlation coefficient (r)=0.33, P<.001) and inversely to mwFS (r=-0.23, P<.001) and a 10-year increase in age was associated with 4.2-g/m(2.7) greater LVMI and 0.5% lower mwFS. Albumin, pulse pressure, cardiovascular comorbidities, and C-reactive protein were age-related risk factors for LVMI and mwFS, whereas hemoglobin was an age-dependent risk factor only for LVMI and heart rate and diabetes mellitus only for mwFS. After adjusting for age-related risk factors, the predictive value of age for cardiomyopathy was substantially less (-67%) and the age-dependent variability in LVMI and mwFS was much attenuated (-61%), and neither was significant.

Conclusion: This study suggests that in people with ESRD, the relationship between age and cardiomyopathy is largely dependent on age-related risk factors and that interventions focused on modifiable risk factors linked to age (e.g., malnutrition and inflammation) could attenuate the detrimental effect of aging on cardiovascular risk in the dialysis population.