STUDY ON EFFICACY OF LOSARTAN ON REGRESSION OF LEFT VENTRICULAR HYPERTROPHY AND IMPROVEMENT IN CARDIAC FUNCTION IN HYPERTENSIVE CHRONIC KIDNEY DISEASE PATIENTS ON HAEMODIALYSIS

Abstract

Introduction: Hypertension is common in hemodialysis patients and can often be difficult to control. Considering the high cardiovascular burden in hemodialysis patients, control of blood pressure is important to improve outcomes. First-line interventions for blood pressure control should focus on sodium restriction, adequate sodium removal during hemodialysis, and attaining an adequate “dry weight.” Despite these interventions, adequate blood pressure control with thrice weekly hemodialysis typically requires the addition of pharmacologic agents.
Objectives of the study: The objectives of the study was to determine the efficacy of losartan in regression of left ventricular hypertrophy and improvement in cardiac function in hypertensive CKD patients on haemodialysis.
Material and Methods: Hypertensive CKD patients of 18-60 years of age on maintenance haemodialysis 3 per week through AV fistula were included in the study. All patients included in the study were be subjected to a uniform evaluation. Demographic data, history,
detailed clinical examination will be recorded in a pro-forma. Informed written consent was obtained from all the patients at the time of enrolment. Laboratory evaluation of all patients included: Complete blood counts, Renal function test, Serum electrolytes (Na/K/Ca/Po4), Liver function test including serum protein and albumin, iPTH and Echo-cardiography (espLA diameter, ejection fraction, left ventricular mass index, E/A) will be done in all patients. These patients were made dry by increasing ultra-filtrate on subsequent haemodialysis. Achievement of dry weight was defined by pre-dialysis BP less than 140/90 with 2or less anti-hypertensives without any clinical oedema. After achieving dry weight losartan treatment was started at a dose of 25 mg/day and increased after one week to a 50 mg/day dose that was maintained to the end of the study (6 months) Result: LA size decreased from 3.30 ± 0.15 cm/m2 to 2.88 ± 0.18 cm/m2 in the losartan arm (n=27) and from 3.33 ± 0.18 cm/m2 to 3.30 ± 0.14 cm/m2 in the control arm (n=25). This change was statistically significant. (p <0.001) E/A decreased from 1.51 ± 0.11 to 1.35 ± 0.10 in the losartan arm (n=27) and from 1.55 ± 0.09 to 1.46 ± 0.12 in the control arm (n=25). This change was statistically significant. (p=0.003) EF% increased from 44.22 ± 4.26 to 56.91 ± 3.90 in the losartan arm (n=27) and from 44.48 ± 4.32 to 48.24 ± 3.74 in the control arm (n=25). This change was statistically significant. (p <0.001) LVMI decreased from170.56 ± 9.19 g/m2 to 146.50 ± 7.54 g/m2 in the losartan arm (n=27) and from 171.16 ± 9.29 g/m2 to 166.0± 8.48 g/m2 in the control arm (n=25). This change was statistically significant. (p <0.001)
Conclusion: In conclusion, in our study, use of losartan improved cardiac parameters (e.g, LA size, E/A ratio, Ejection fraction and left ventricular mass index) significantly in the hypertensive chronic kidney disease haemodialysis dependant patients after our study period of 6 months.