Volume indicators and left ventricular mass during aggressive volume management in patients on thrice-weekly hemodialysis

OBJECTIVE

We examined the relationship between various volume indicators, i.e. multifrequency bioelectric impedance analysis (BIA), predialysis serum N-terminus-pro-brain natriuretic peptide (NT[-]pro[-]BNP) levels, and inferior vena cava diameter, and left ventricular mass index (LVMI) at baseline and with rigorous volume management on thrice-weekly hemodialysis.

METHODS

Twenty-two patients on chronic thrice-weekly hemodialysis were followed for 52 weeks. Left ventricular hypertrophy was present in 100% of the cohort at baseline.

RESULTS

There were no significant correlations among volume indicators except for a correlation between extracellular-volume-to-body-mass ratio and collapsibility index (r = 0.476; p = 0.039) at 6 months. There were no correlations between blood pressure and volume indicators. Baseline (but not follow-up) collapsibility index correlated with LVMI (r = 0.506; p = 0.038). In 'lag-time' analyses, there were no correlations between volume indicators at baseline or 6 months and LVMI at subsequent time points. LVMI decreased from 243.6 +/- 83.3 g/m(2) at baseline to 210.6 +/- 62.9 g/m(2) at 6 months (p = 0.104) and further to 203.2 +/- 49.0 g/m(2) at 12 months (p = 0.035).

CONCLUSIONS

(1) Left ventricular hypertrophy was prevalent in hemodialysis patients; (2) BIA, inferior vena cava ultrasound and serum NT-pro-BNP levels yield discordant results for fluid volumes; (3) regression of LVMI could occur with rigorous fluid management, even with thrice-weekly dialysis.