Dana Ahmed Sharif a , Salar Mohammed Amin b and Deler Shamsulddin Hamid a

a  Department of Medicine , College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.

b Kurdistan Board Candidate  

Submitted: 24/3/2019; Accepted: 3/5/2019; Published: 21/6/2019

DOI Link: https://doi.org/10.17656/jsmc.10195 



Left ventricular hypertrophy (LVH) is an independent predictor for cardiovascular events in chronic kidney disease (CKD).


To find relationship between left ventricular hypertrophy and CKD stages during predialysis period and assess risk factors in CKD patients for left ventricular hypertrophy.


This cross-sectional study of 125 participant with CKD was conducted at Shar Teaching Hospital of Nephrology department, Sulaimani, Iraq. Left ventricular mass index (LVMI) was measured by using two-dimensional echocardiogram in the left decubitus position. LVH was labeled when the left ventricular mass index was >115 g/m² in men, and >95 g/m² in women on echocardiogram. We analyzed the baseline characteristic in 125 patients with chronic kidney diseaase. All patients underwent laboratory investigations which included serum creatinine, complete blood count, serum calcium, phosphate, intact parathyroid hormone, high density lipoprotein cholesterol HDL-C, low density lipoprotein LDL-C, triglyceride, and total cholesterol with urine albumin to creatinine ratio.


The mean age was 55.27± 14.51 years(male 60.0%, female 40.0%), and the prevalence of LVH was 68.0%, and it was increased with progressive decline in estimated glomerular filtration rate(eGFR) (P =0.005). independent risk factors for LVH were anemia (P =0.000), systolic and diastolic BP (P =0.000; P =0.001 respectively), intact PTH (P =0.038), body mass index BMI(P =0.045), serum calcium (P =0.003),serum phosphate (P =0.001) and majority of lipid profiles. 


There was a high prevalence of LVH in the CKD patients and it was increased with progressively decline in renal function. There was a significant association between systolic and diastolic BP, intact PTH, hemoglobin level, BMI, and minerals with LVH in CKD patients.


Chronic Kidney Disease, Left Ventricular Hypertrophy.


1. Amoako YA, Laryea DO, Bedu-Addo G, Nkum BC, Plange-Rhule J. Left ventricular hypertrophy among chronic kidney disease patients in Ghana. Pan Afr Med J. 2017;28:79. 

2. De Roij Van Zuijdewijn CLM, Hansildaar R, Bots ML, Blankestijn PJ, Van Den Dorpel MA, Grooteman MPC, et al. Eccentric Left Ventricular Hypertrophy and Sudden Death in Patients with End-Stage Kidney Disease. Am J Nephrol. 2015;42(2):126–33. 

3. Muntner P, He J, Astor BC, Folsom AR, Coresh J. Traditional and Nontraditional Risk Factors Predict Coronary Heart Disease in Chronic Kidney Disease: Results from the Atherosclerosis Risk in Communities Study. J Am Soc Nephrol [Internet]. 2005 Feb [cited 2019 Mar 18];16(2):529–38. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15625072

4. Parfrey PS, Foley RN, Harnett JD, Kent GM, Murray DC, Barre PE. Outcome and risk factors for left ventricular disorders in chronic uraemia. Nephrol Dial Transplant [Internet]. 1996 Jul [cited 2019 Mar 18];11(7):1277–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8672023

5. Glassock RJ, Pecoits-Filho R, Barberato SH. Left ventricular mass in chronic kidney disease and ESRD. Clin J Am Soc Nephrol [Internet]. 2009 Dec 1 [cited 2019 Mar 18];4 Suppl 1(Supplement 1):S79-91. Available from: http://cjasn.asnjournals.org/cgi/doi/10.2215/CJN.04860709

6. Amann K, Rychlík I, Miltenberger-Milteny G, Ritz E. Left ventricular hypertrophy in renal failure. Kidney Int Suppl [Internet]. 1998 Dec [cited 2019 Mar 18];68:S78-85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9839289

7. Cioffi G, Tarantini L, Frizzi R, Stefenelli C, Russo TE, Selmi A, et al. Chronic kidney disease elicits excessive increase in left ventricular mass growth in patients at increased risk for cardiovascular events. J Hypertens [Internet]. 2011 Mar [cited 2019 Mar 18];29(3):565–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21150636

8. Pecoits-Filho R, Barberato SH. Echocardiography in Chronic Kidney Disease: Diagnostic and Prognostic Implications. Nephron Clin Pract [Internet]. 2010 [cited 2019 Mar 18];114(4):c242–7. Available from: https://www.karger.com/Article/FullText/276575

9. Tikellis G, Arnett DK, Skelton TN, Taylor HW, Klein R, Couper DJ, et al. Retinal arteriolar narrowing and left ventricular hypertrophy in African Americans. the Atherosclerosis Risk in Communities (ARIC) study. Am J Hypertens [Internet]. 2008 Mar 1 [cited 2019 Mar 18];21(3):352–9. Available from: https://academic.oup.com/ajh/article-lookup/doi/10.1038/ajh.2007.57

10. Hogg RJ, Furth S, Lemley K V, Portman R, Schwartz GJ, Coresh J, et al. National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: evaluation, classification, and stratification. Pediatrics [Internet]. 2003 Jun [cited 2019 Mar 18];111(6 Pt 1):1416–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12777562

11. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med [Internet]. 2006 Aug 15 [cited 2019 Mar 18];145(4):247–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16908915

12. Post WS, Blumenthal RS, Weiss JL, Levine DM, Thiemann DR, Gerstenblith G, et al. Spot urinary albumin-creatinine ratio predicts left ventricular hypertrophy in young hypertensive African-American men. Am J Hypertens [Internet]. 2000 Nov [cited 2019 Mar 18];13(11):1168–72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11078176

13. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr [Internet]. 2005 Dec [cited 2019 Mar 18];18(12):1440–63. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0894731705009831

14. Eghan BA, Amoako-Atta K, Kankam CA, Nsiah-Asare A. Survival pattern of hemodialysis patients in Kumasi, Ghana: a summary of forty patients initiated on hemodialysis at a new hemodialysis unit. Hemodial Int [Internet]. 2009 Oct [cited 2019 Mar 18];13(4):467–71. Available from: http://doi.wiley.com/10.1111/j.1542-4758.2009.00379.x

15. Abdulkader RCRM, Burdmann EA, Lebrão ML, Duarte YAO, Zanetta DMT. Aging and decreased glomerular filtration rate: An elderly population-based study. Ashton N, editor. PLoS One [Internet]. 2017 Dec 19 [cited 2019 Mar 18];12(12):e0189935. Available from: https://dx.plos.org/10.1371/journal.pone.0189935

16. Aktas Yilmaz B, Mete T, Dincer I, Kutlay S, Sengül S, Keven K, et al. Predictors of Left Ventricular Hypertrophy in Patients with Chronic Kidney Disease. Ren Fail [Internet]. 2007 Jan 7 [cited 2019 Mar 18];29(3):303–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17497444

17. Ha SK, Park HS, Kim SJ, Park CH, Kim DS, Kim HS. Prevalence and patterns of left ventricular hypertrophy in patients with predialysis chronic renal failure. J Korean Med Sci [Internet]. 1998 Oct [cited 2019 Mar 18];13(5):488. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9811177

18. Ali T, Idrees MK, Shoukat, Akhtar SF. Left ventricular hypertrophy among predialysis chronic kidney disease patients: Sindh institute of urology and transplantation experience. Saudi J Kidney Dis Transpl [Internet]. 2017 [cited 2019 Mar 18];28(6):1375–80. Available from: http://www.sjkdt.org/text.asp?2017/28/6/1375/220856

19. Glassock RJ, Pecoits-Filho R, Barbareto S. Increased Left Ventricular Mass in Chronic Kidney Disease and End-Stage Renal Disease: What Are the Implications? Dial Transplant [Internet]. 2010 Jan 1 [cited 2019 Mar 18];39(1):16–9. Available from: http://doi.wiley.com/10.1002/dat.20391

20. Sambi RS, Gaur AK, Hotchandani R, Aggarwal KK, Kaur S, Gupta M, et al. Patterns of left ventricular hypertrophy in chronic kidney disease: an echocardiographic evaluation. Indian Heart J [Internet]. [cited 2019 Mar 18];63(3):259–68. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22734347

21. Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention. Am J Kidney Dis [Internet]. 1996 Mar [cited 2019 Mar 18];27(3):347–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8604703

22. Grabysa R, Wańkowicz Z. Echocardiographic markers of left ventricular dysfunction among men with uncontrolled hypertension and stage 3 chronic kidney disease. Med Sci Monit [Internet]. 2013 Oct 9 [cited 2019 Mar 18];19:838–45. Available from: http://www.medscimonit.com/abstract/index/idArt/889586

23. Shlipak MG, Lash JP, Yang W, Teal V, Keane M, Cappola T, et al. Symptoms characteristic of heart failure among CKD patients without diagnosed heart failure. J Card Fail [Internet]. 2011 Jan [cited 2019 Mar 18];17(1):17–23. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1071916410010882

24. Devereux RB, Roman MJ, Liu JE, Welty TK, Lee ET, Rodeheffer R, et al. Congestive heart failure despite normal left ventricular systolic function in a population-based sample: the Strong Heart Study. Am J Cardiol [Internet]. 2000 Nov 15 [cited 2019 Mar 18];86(10):1090–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11074205

25. Asp AM, Wallquist C, Rickenlund A, Hylander B, Jacobson SH, Caidahl K, et al. Cardiac remodelling and functional alterations in mild-to-moderate renal dysfunction: comparison with healthy subjects. Clin Physiol Funct Imaging [Internet]. 2015 May [cited 2019 Mar 18];35(3):223–30. Available from: http://doi.wiley.com/10.1111/cpf.12154

26. Silberberg JS, Rahal DP, Patton DR, Sniderman AD. Role of anemia in the pathogenesis of left ventricular hypertrophy in end-stage renal disease. Am J Cardiol [Internet]. 1989 Jul 15 [cited 2019 Mar 18];64(3):222–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2525871

27. Weiner DE, Tighiouart H, Vlagopoulos PT, Griffith JL, Salem DN, Levey AS, et al. Effects of Anemia and Left Ventricular Hypertrophy on Cardiovascular Disease in Patients with Chronic Kidney Disease. J Am Soc Nephrol [Internet]. 2005 Jun [cited 2019 Mar 18];16(6):1803–10. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15857925

28. Foley RN, Parfrey PS, Harnett JD, Kent GM, Martin CJ, Murray DC, et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int [Internet]. 1995 Jan [cited 2019 Mar 18];47(1):186–92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7731145

29. Devereux RB, Pickering TG, Alderman MH, Chien S, Borer JS, Laragh JH. Left ventricular hypertrophy in hypertension. Prevalence and relationship to pathophysiologic variables. Hypertens (Dallas, Tex 1979) [Internet]. 1987 Feb [cited 2019 Mar 18];9(2 Pt 2):II53-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2879790

30. Parfrey P s., Griffiths SM, Harnett JD, Taylor R, King A, Hand J, et al. Outcome of Congestive Heart Failure, Dilated Cardiomyopathy, Hypertrophic Hyperkinetic Disease, and Ischemic Heart Disease in Dialysis Patients. Am J Nephrol [Internet]. 1990 [cited 2019 Mar 18];10(3):213–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/2143353

31. Locatelli F, Bommer J, London GM, Martín-Malo A, Wanner C, Yaqoob M, et al. Cardiovascular disease determinants in chronic renal failure: clinical approach and treatment. Nephrol Dial Transplant [Internet]. 2001 Mar [cited 2019 Mar 18];16(3):459–68. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11239016

32. Nitta K, Iimuro S, Imai E, Matsuo S, Makino H, Akizawa T, et al. Correction to: Risk factors for increased left ventricular hypertrophy in patients with chronic kidney disease: findings from the CKD-JAC study. Clin Exp Nephrol [Internet]. 2019 Jan 9 [cited 2019 Mar 18];23(1):99–99. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30094596

33. Randon RB, Rohde LE, Comerlato L, Ribeiro JP, Manfro RC. The role of secondary hyperparathyroidism in left ventricular hypertrophy of patients under chronic hemodialysis. Brazilian J Med Biol Res = Rev Bras Pesqui medicas e Biol [Internet]. 2005 Sep [cited 2019 Mar 18];38(9):1409–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16138225

34. Dell’omo G, Giorgi D, Di Bello V, Mariani M, Pedrinelli R. Blood pressure independent association of microalbuminuria and left ventricular hypertrophy in hypertensive men. J Intern Med [Internet]. 2003 Jul [cited 2019 Mar 18];254(1):76–84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12823644

35. McQuarrie EP, Patel RK, Mark PB, Delles C, Connell J, Dargie HJ, et al. Association between proteinuria and left ventricular mass index: a cardiac MRI study in patients with chronic kidney disease. Nephrol Dial Transplant [Internet]. 2011 Mar 1 [cited 2019 Mar 18];26(3):933–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20624770

36. Alpert MA. Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome. Am J Med Sci [Internet]. 2001 Apr [cited 2019 Mar 18];321(4):225–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11307864

37. Kotsis V, Stabouli S, Toumanidis S, Tsivgoulis G, Rizos Z, Trakateli C, et al. Obesity and daytime pulse pressure are predictors of left ventricular hypertrophy in true normotensive individuals. J Hypertens [Internet]. 2010 May [cited 2019 Mar 18];28(5):1065–73. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20411600

38. Guerra F, Mancinelli L, Angelini L, Fortunati M, Rappelli A, Dessì-Fulgheri P, et al. The Association of Left Ventricular Hypertrophy with Metabolic Syndrome is Dependent on Body Mass Index in Hypertensive Overweight or Obese Patients. Federici M, editor. PLoS One [Internet]. 2011 Jan 31 [cited 2019 Mar 18];6(1):e16630. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21304952

39. Chue CD, Edwards NC, Moody WE, Steeds RP, Townend JN, Ferro CJ. Serum phosphate is associated with left ventricular mass in patients with chronic kidney disease: a cardiac magnetic resonance study. Heart [Internet]. 2012 Feb 1 [cited 2019 Mar 18];98(3):219–24. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22021416

40. Di Lullo L, Gorini A, Russo D, Santoboni A, Ronco C. Left Ventricular Hypertrophy in Chronic Kidney Disease Patients: From Pathophysiology to Treatment. Cardiorenal Med [Internet]. 2015 Oct [cited 2019 Mar 18];5(4):254–66. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26648942


Full Text

 © The Authors, published by University of Sulaimani, College of Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.