Left atrial volume in end-stage renal disease: a prospective cohort study

J Hypertens. 2006 Jun;24(6):1173-80. doi: 10.1097/01.hjh.0000226208.11184.bb.


Background: End-stage renal disease (ESRD) is a high-risk condition and left ventricular hypertrophy (LVH) is the strongest risk factor in this population.

Objective and methods: Since the prognostic value of left atrial (LA) size in ESRD is still unknown, we performed a prospective cohort study aimed at testing the prognostic value of LA volume in a cohort of 249 ESRD patients.

Results: Both un-indexed and indexed LA volume (LAV) was significantly higher in dialysis patients than in healthy subjects (P < 0.001). On multivariate analysis only left ventricular mass index (LVMI), LV ejection fraction (LVEF), ratio of early (E) to late atrial (A) mitral Doppler peak flow velocity (E/A ratio) and antihypertensive treatment maintained an independent association with LAV. During the follow-up 113 patients died. LAV added significant prognostic power to a multivariate Cox model of all-cause death and the model based on height provided the best data fit. Notably, this index maintained an independent predictive value for death (P = 0.03) also when LVMI and LVEF were jointly forced into the Cox's model. Neither crude nor body surface area (BSA)-adjusted LAV had an independent association with death when tested in the Cox model including LVMI and LVEF.

Conclusions: In patients with ESRD, LAV indexed for height displays prognostic value beyond and above that provided by LV mass and function.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Body Height
  • Body Surface Area
  • Cardiac Volume / physiology
  • Cause of Death
  • Female
  • Heart Atria / pathology*
  • Heart Atria / physiopathology
  • Heart Ventricles / pathology
  • Humans
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / pathology*
  • Kidney Failure, Chronic / physiopathology
  • Male
  • Middle Aged
  • Prospective Studies
  • Ventricular Dysfunction / pathology