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INTRODUCTION: CARDIOVASCULAR PATHOLOGY IS PRESENT IN MORE THAN 50% OF PATIENTS WHO START HEMODIALYSIS (HD), BEING THE MAIN CAUSE OF MORTALITY, BEING 10 TO 30 TIMES HIGHER COMPARED TO THE GENERAL POPULATION, EVEN WITH ADJUSTMENT FOR OTHER VARIABLES SUCH AS SEX OR DIABETES.
ECCENTRIC LEFT VENTRICULAR HYPERTROPHY (LVH-E) IS THE MOST FREQUENT CARDIAC ALTERATION, BEING AN INDEPENDENT FACTOR OF MORTALITY. THE OBJECTIVE OF THIS WORK WAS TO OBSERVE THE PREVALENCE OF LVH-E WHICH DEVELOPS AS A MECHANISM OF ADAPTATION OF THE CARDIAC MUSCLE TO A MAINTAINED EXCESS OF WORK DUE TO PRESSURE OVERLOAD BY VOLUME, AND ITS CORRELATION WITH MINERAL AND BONE DISORDER (BMD) AND OTHER VARIABLES OF INTEREST IN OUR HEMODIALYSIS POPULATION.
MATERIALS AND METHODS: AN OBSERVATIONAL AND TRANSVERSAL STUDY WAS CONDUCTED WITH THE OBJECTIVE OF EVALUATING THE ASSOCIATION OF LVH-E AND POOR PROGNOSIS VARIABLES IN THE NEPHROLOGY SERVICE IN A HOSPITAL IN BUENOS AIRES-ARGENTINA, IN A POPULATION OF 36 PATIENTS IN THREE-WEEKLY HEMODIALYSIS WITH 4-HR SESSIONS. REGARDING VASCULAR ACCESS: 61.2% DIALIZED THROUGH AVF AND 38.8% DIALYZED BY NON-TUNNELED CATHETER (CNT). HIGH FLUX POLYETEROSULPHONE WITHOUT REUSE, AVERAGE KT/V 1.53.
THE CARDIAC EVALUATION WAS PERFORMED BY TRANSTHORACIC DOPPLER ECHOCARDIOGRAM.
THE STATA 14.2 PROGRAM WAS USED FOR THE STATISTICAL ANALYSIS. THE INCLUSION CRITERIA WERE: PATIENT OVER 18 YEARS OLD, BETWEEN 6 MONTHS AND 5 YEARS IN HD. OF THE 61 PATIENTS IN OUR POPULATION, 36 WERE SELECTED. EXCLUSION CRITERIA: PATIENTS WHO CHANGED DIALYTIC MODALITY IN THE LAST 6 MONTHS.
THE MEDIAN AGE WAS 56 YEARS (SD 10), 72% WERE MEN AND THE MEDIAN MONTHS ON HD WAS 16.5 (IQR 7.5-24.5). 44% WERE DIABETIC AND 88% HAD ARTERIAL HYPERTENSION. THE MEAN EJECTION FRACTION WAS 55% (SD 11.40). THE PREVALENCE OF LVH-E WAS 25.81%. THE MEDIAN PTH WAS 294 PG/ML (IQR 113-391), 380 PG/ML IN THE LVH-E GROUP VS 359 PG/ML IN THOSE WITHOUT THIS ENTITY (P=0.95). IN PATIENTS WITH LVH-E, THE MEAN POSPHORUS WAS 6.03 MG/DL (DS1.39) VS 5.3 MG/DL (SD 1.39) IN THE POPULATION WITHOUT LVH-E (P=0.37).
WHEN IT WAS EVALUATED IF THE TIME IN HD CORRELATED WITH LVH-E, IT WAS OBSERVED THAT THE LONGER THE TIME IN HD, THE MORE LVH-E. PATIENTS WHO PRESENTED LVH-E HAD BEEN ON HD FOR 28 MONTHS (DS 17) COMPARED TO 17 MONTHS (DS 13) IN THE NON LVH-E GROUP (P=0.05).
THE AVERAGE RESIDUAL DIURESIS WAS 1050 ML (IQR 375-1500 ML) 462 ML- DS 480 ML (LVH-E) VS 1112 ML - DS 650 ML (PATIENTS WITHOUT LVH-E) (P=0.01).
CONCLUSIONS: THERE IS A LIMITATION OF RESOURCES FOR THE TREATMENT OF BMD IN OUR ENVIRONMENT, WHERE THE ADEQUACY IS DIRECTED AT THE CONTROL OF HYDROSALINE OVERLOAD, BLOOD TENSION, ANEMIA AND KT/V. THE MANAGEMENT OF BMD IS A CHALLENGE BECAUSE LACK OF ACCESS TO MEDICAL TREATMENT WITH HIGH COST DRUGS AND THE SOCIO-ECONOMIC LEVEL OF THE MAJORITY OF OUR PATIENTS.
DESPITE THIS, THE RESULTS DO NOT LEAVE US FAR FROM WHAT IS REPORTED IN THE LITERATURE REGARDING THE PREVALENCE OF LVH-E REPORTED IN 15-30% OF THE DIALYTIC POPULATION. WE WERE ABLE TO SHOW THAT, IN OUR PATIENTS, THE PREVALENCE OF LVH-E IS 25.81%. THE TWO FACTORS TO HIGHLIGHT FROM OUR STUDY WERE THE TIME ON THERAPY AND THE RESIDUAL DIURESIS. WE COULD NOT DEMONSTRATE THE RELATIONSHIP BETWEEN BMD AND LVH-E. WE BELIEVE THAT A LIMITATION WAS THE RELATIVE LITTLE TIME IN THE DIALYSIS PROGRAM OF THE STUDY POPULATION.