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LVH Dialysis Multifactorial — ESENeph MCQ

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ModerateHaemodialysisLVH Dialysis MultifactorialESENeph

A 65-year-old man on haemodialysis has developed significant left ventricular hypertrophy (LVH) on echocardiography. He has well-controlled pre-dialysis BP. What factors specific to dialysis promote LVH?

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Correct answer: A — Volume overload (interdialytic fluid gains), AV fistula flow, anaemia, arterial stiffness from vascular calcification, and uraemic cardiomyopathy all contribute to LVH in dialysis patients – it affects >70% of HD patients

LVH affects >70% of haemodialysis patients and is a major predictor of cardiovascular mortality. Dialysis-specific contributors include: (1) chronic volume overload (even modest interdialytic weight gains promote LV dilation); (2) AV fistula creating a continuous left-to-right shunt increasing preload; (3) anaemia (increased cardiac output to maintain oxygen delivery); (4) arterial stiffness from medial calcification (increasing afterload); (5) uraemic cardiomyopathy (direct uraemic toxin effects on myocardium). Management targets all modifiable factors: strict volume control, anaemia correction, BP management, phosphate control, and adequate dialysis.

Reference: ERA-EDTA 2019 – CV Risk in HD; KDOQI 2015 – HD Adequacy