Jenifer Sinekalatha, M (2014) Predictors of Left Ventricular Mass in Chronic Kidney Disease - eGFR and protienuria. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
BACKGROUND : Chronic kidney disease is the growing epidemic of the 21st century. With the rising burden of diabetes and hypertension, chronic kidney disease is becoming rampant in our country. About 40 – 50% of the death in chronic kidney disease patients is attributed to cardiovascular causes. Individuals with the most severe form of chronic kidney disease have a risk for cardiac death 15 times higher than patients with preserved glomerular filtration rate. The two classical features of cardiac disease in end stage renal disease (ESRD) are atherosclerotic vascular disease and left ventricular hypertrophy. The prevalence of left ventricular hypertrophy is around 80% in a dialysis population. Multiple afterload and preload related factors act in the pathogenesis of this uremic cardiomyopathy, which once initiated, lead on to myocyte ischemia and myocardial fibrosis and eventually death. Hence if the risk factors which contributed to left ventricular hypertrophy in chronic kidney disease patients could be lined out, it would be possible to prevent and regress the left ventricular wall thickness. In our study, two variables glomerular filtration rate and the amount of proteinuria are used to predict the left ventricular mass index in chronic kidney disease. AIMS AND OBJECTIVES : 1. To calculate the left ventricular mass index in CKD patients who are maintained on conservative medical management. 2. To calculate the glomerular filtration rate of CKD patients using 24 hour creatinine clearance and Cockcroft Gault formula and the amount of proteinuria using urine spot PCR and 24 hour quantification. 3. To study whether there is a significant correlation between the amount of proteinuria and glomerular filtration rate to the left ventricular mass index. 4. To also correlate the association between other variables in chronic kidney disease and left ventricular mass index. MATERIALS AND METHODS : A total of 75 patients attending the Nephrology OP and admitted in the Nephrology ward satisfying the inclusion and exclusion criteria were included in the study over a period of 6 months. Blood samples and urine samples were drawn at the time of admission and in the Outpatient department for urine spot protein creatinine ratio calculation and renal function test. 24 hour urine collection was scrutinized and analysed for proteinuria quantification and creatinine clearance. Left ventricular mass was measured using 2D Echocardiography. Devereux formula was used for the calculation of left ventricular mass index. OBSERVATION AND RESULTS : Among the variables studied age and sex of the patient, prevalence of diabetes and hypertension in the study population, systolic blood pressure, diastolic blood pressure, serum albumin and hemoglobin, serum alkaline phosphatase, total cholesterol and serum triglycerides, blood urea of the patients in the study group did not have a significant p value, suggesting that all these variables did not influence or predict the development of left ventricular hypertrophy in chronic kidney disease patients in our study. The variables duration of chronic kidney disease, serum creatinine, creatinine clearance (24 hour urine estimation, Cockcroft Gault equation, and MDRD equation), and urine spot PCR and 24 hour proteinuria all had a significant p value demonstrating their predictive potential for left ventricular hypertrophy in chronic kidney disease. Among the significant parameters, a statistically highly significant negative correlation was observed between declining GFR (Stage 4/5) and increased left ventricular mass index (p value < 0.001). Highly significant positive correlation was also observed with serum creatinine values and increased left ventricular mass (p value < 0.001). Regarding proteinuria, a highly significant positive correlation was obtained between urine spot protein creatinine ratio, 24 hour urine protein and the left ventricular wall thickness (p value < 0.001). These parameters were found to be significant in both univariate and multivariate regression analysis. CONCLUSION: 1. Glomerular filtration rate and the amount of proteinuria significantly influence the left ventricular wall thickness in chronic kidney disease patients. 2. Declining GFR had a strong negative correlation with left ventricular mass, where the amount of protein excreted positively predicted the significant risk of left ventricular hypertrophy in these patients. 3. These predictors of LV mass could be easily measured and are highly sensitive and specific for the same. 4. Hence routine measurement of these variables, and its correlation to left ventricular thickness could be easily ascertained compared to the costly investigations like cardiac MRI and Echocardiography. 5. On arriving at a suspicion of possible LV hypertrophy, rigorous measures to reduce protein excretion and frequent hemodialysis session could improve patients survival from the deadly cardiovascular diseases.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Chronic kidney disease, left ventricular hypertrophy, left ventricular mass index, glomerular filtration rate, proteinuria, cardiovascular disease, Devereux formula. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Pushparaj A |
| Date Deposited: | 18 Jul 2017 06:49 |
| Last Modified: | 03 Feb 2018 10:02 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1782 |
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