Abstract
We investigated possible differences in left ventricular hypertrophy (LVH) between hemodialysis patients with or without diabetes mellitus. Left ventricular mass index (LVMI), interventriculr septal wall thickness (IVST), and relative left ventricular wall thickness (rLVWT) were measured in 486 subjects receiving maintenance hemodialysis in Toujinkai Hospital (diabetic, n=145, non-diabetic, n=341) using ultrasonic echocardiography before hemodialysis. Blood was collected before the start of hemodialysis, and hmtcrit values and plasma concentrations of aldosterone and B-type natriuretic peptide (BNP), a humoral parameter indicating left ventricular wall stress, were measured by RIA or ELISA methods. In non-diabetic subjects, plasma BNP concentration showed a positive correlation with LVMI (r=0.245, p=0.0001), IVST (r=0.250, p=0.0001), or rLVWT (r=0.149, p=0.006). LVMI was positively correlated with mean blood pressure and pulse pressure before and after dialysis; IVST and rLVWT were positively correlated with pulse pressure before and after dialysis. In contrast, factors investigated in this study, including plasma concentrations of BNP and aldosterone, hematocrit, mean blood pressure or pulse pressure, were not associated with LVMI, IVST or rLVWT in diabetic subjects. Plasma BNP concentration was positively correlated with end-systolic or end-diastolic left intraventricular dimensions in diabetic subjects, but not in non-diabetic subjects. In non-diabetic hemodialysis patients, increased stress caused concentric LVH via myocardial remodeling; however, this left ventricular wall remodeling induced either volume or pressure overload which may be a compensatory mechanism against left ventricular overload appears to impaired in diabetic hemodialysis patients.
