말기 신부전 환자에서 투석 방법에 따른 좌심실 형태 변화의 영향
Impact of Dialysis Modality on Left Ventricular Geometry in End Stage Renal Disease Patients
- 주제(키워드) Hypertrophy , Geometry , End stage renal disease
- 발행기관 아주대학교
- 지도교수 신규태
- 발행년도 2014
- 학위수여년월 2014. 2
- 학위명 석사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000016578
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Background: Left ventricular hypertrophy (LVH) is an independent risk factor for morbidity and mortality in patients with end stage renal disease (ESRD). This study aimed to evaluate impact of dialysis modality on LV geometry by using echocardiography. Methods: We retrospectively evaluated change in LV mass index (LVMI), relative wall thickness (RWT) and LV geometry, assessed by 2D transthoracic echocardiography, in patients starting dialysis while hospitalized from 2002 to 2012. Patients were classified into hemodialysis (HD) group and peritoneal dialysis (PD) group. Follow-up duration performing echocardiogram was 15±7months in HD group and 17±8 months in PD group. LV geometry was divided into 4 groups as normal LV geometry, concentric remodeling, concentric LVH and eccentric LVH according to LVMI and RWT using cutoff values of 115 (men) or 95 (women) g/m² for LVMI and 0.42 for RWT, both men and women. Severity of LVH was followed ASE recommendation (for men; mild: 116-131g/m2, moderate: 132-148 g/m², severe: ≥149 g/m², for women; mild: 96-108 g/m², moderate:109-121 g/m², severe: ≥122 g/m²) of LVMI. The multivariate analysis was performed to evaluate the independent predictors 10% reduction of LVMI Results: 84 patients with HD (age 55±13years, 51% male) and 36 patients with PD (age 50±14years, 61% male) were enrolled. Before initiation of dialysis, there were no significant difference of ejection fraction, LVMI, RWT (56±14% vs. 56±14%, p=0.810; 166.7±46.0g/m² vs. 167.8±54.6g/m², p=0.910; 0.46±0.10 vs. 0.46±0.08, p=0.960, respectively). Concentric LVH was most common in both groups before initiating dialysis (58% vs. 64%). In HD group, there was no difference in LVMI (166.7±46.0g/m2 vs. 165.5±47.2g/m2, p=0.799) at follow-up, PD group had significant reduction of LVMI (164.8±54.6g/m2 vs. 145.1±43.1g/m2, p=0.021). Incidence of 10% reduction of LVMI was higher in PD group (33% vs. 56%, p=0.026). Predominance of concentric LVH did not changed in both groups at follow-up (61% vs. 61%). Patients with PD had decrease of severe LVH 67% to 50% and increase of normal LV 6% to 22% but it was no significant difference (p=0.090). By multivariable linear regression for predicting 10% LVMI regression, Independent predictors were presence of PD (odds ratio[OR]:2.119, 95% confidence interval [CI]:1.041-4.736, p=0.048), Diabetes mellitus (OR:0.464, 95%CI: 0.203-8.213, p=0.033), coronary artery disease (OR:0.339, 95%CI: 0.339-8.213, p=0.037 ), serum calcium (OR:0.579, 95%CI:0.293-1.134, p=0.011). Conclusion: Otherwise there was no difference in prevalence of LV geometry pattern on baseline and follow up echocardiography, PD patients had reduction of LVMI and PD was an independent predictor for LVMI reduction
more목차
ABSTRACT i
TABLE OF CONTENTS iii
LIST OF FIGURES iv
LIST OF TABLES v
I. INTRODUCTION 1
II. MATERIAL AND METHODS 2
A. PATIENTS 2
B. DIALYSY 2
C. PHYSICAL PARAMETERS & LABARATORY PARAMETERS 2
D. ECHOCARDOGRAPHIC PARAMATERTS 3
E. STATISTICS 4
III. RESULTS 5
A. BASELINE CHARACTERISTICS 5
B. COMPARISON IN CHANGE OF LABORATORY AND ECHOCARDIOGRAPHIC PARAMETERS AFTER DIAYSIS 9
IV. DISCUSSION 17
V. CONCLUSION 20
REFERENCES 21
국문요약 24
