LVH: Heading Off a Common Heart Problem

As the old song goes, "the knee bone's connected to the leg bone...." Kidney failure affects your whole body, and your heart can be first in line for harm. We'll tell you how to prevent it (hint: home dialysis can help!), what tests to ask about, and how to protect your heart.

The heart is a lonely pumper

Diagram of the heart Your heart pumps your blood through a 100,000 mile loop of blood vessels, 80 times or so per minute, 24 hours a day. That's about 42 million beats a year.

Four chambers make this happen—two atria take blood in from your veins, and two ventricles pump it out through your arteries to your lungs and the rest of your body. Valves are doors that keep the blood from backing up. (In fact, the "lub-dub" sound of a heartbeat is heard when your valves open and close.)

Meet the problem: LVH

A common heart problem in people on dialysis occurs when the muscle of the main pumping chamber grows too thick. This is left ventricular hypertrophy (LVH). LVH can make your heart stiff and take up space that is needed for blood. This can lead to slow heart failure—or sudden death. A study that tracked in-center hemodialysis (HD) patients for 10 years found that LVH was the strongest predictor of sudden death. 1

From 16.4% 2 to 75.9% 3 of people on dialysis have LVH—which starts early in kidney disease. 4 Diabetes adds to the problem; with it, the function of the left ventricle is not as strong, even when the degree of LVH is the same. 5

How to prevent LVH

The main cause of LVH on dialysis is too much fluid, which leads to high blood pressure. 6 Inside the body, water is in three "compartments":

Dialysis can only remove water that is in your bloodstream—but 2/3 of your body water is inside your cells. So, if you gain a lot of water, standard hemodialysis (HD) done three times a week can't remove it all. This can cause high blood pressure and LVH.

On PD, keeping blood pressure normal and eating less salt help LVH. 7 On standard HD, sodium modeling can reduce symptoms—but it also leaves your body with extra salt, so you are thirsty and may gain more water weight. 8 You can help prevent LVH by eating a low salt diet and limiting fluid weight gain between treatments.

Daily and nocturnal HD can help

Stiff, calcified arteries 9 or too much beta-2 microglobulin 10 (which also leads to joint damage) can add to LVH. These problems improve with longer or more-frequent HD. Daily and nocturnal HD remove more water from the bloodstream and from inside cells; these treatments can help prevent (or treat) LVH. In a year-long study, both options helped reduce left ventricular mass more than in-center HD. 11

Patients who switched to daily HD with the same dialysis adequacy (Kt/V) had less fluid between their cells, lower blood pressure, and lower left ventricular mass than when they did standard HD, and high-risk patients who switched to daily HD had less left ventricular mass—and lots of other pluses, like higher albumin levels, better bone health, less pain, more energy, and better physical function. 12

Nocturnal HD has improved LVH in patients with known heart problems. 13 The treatment helped make patients' arteries less stiff so they respond as they should to stress. 14 Compared to patients who stayed on in-center treatment three times per week, those who switched to nocturnal HD had less LVH and lower blood pressure. 15

Do you have LVH?

The good news is that LVH can be reversed. 3 If you don't have it, you can help prevent it. And if you do have it, you can take steps to improve your heart health. Ask your doctor about getting tested for LVH—you can have it with no symptoms (or you may be short of breath, dizzy, or have chest pain). Research has found a number of tests that can check for the problem.

an "echo" uses painless sound waves to show your pumping chambers and valves. It will reveal the size and function of your left ventricle (see figures 1 and 2 below), which can predict future problems. 16
24-hour blood pressure (BP)
with a small machine on your belt and a cuff on your arm, your BP can be checked all day and night. This tells your doctor much more than a single check. If your BP is high all the time 2,17,18,19 or does not drop at night 20 (it should), you are at risk for heart problems.
Bioimpedance analysis (BIA)
checks for fluid overload by looking for water in and outside of your cells. The technique, which uses sensors placed on your head and neck (Bio-Z), is painless and not invasive. BIA predicts LVH on dialysis. 21
C-reactive protein (CRP)
a CRP blood test measures inflammation, which has been linked to heart damage in people on dialysis. 22,23 Even one high CRP test level can predict heart risk in people on PD. 24
Cardiac troponin T (CTnT)
a blood test that is a marker for damage to the heart muscle itself. It adds value to an echo and has been shown to predict results in people on dialysis in research. 25,26,27
Tumor necrosis factor alpha (TNF-alpha)
a group of proteins that tell cells when to die. In a study, this test was able to predict LVH in people on dialysis. 28 (It is not yet being used for this purpose in routine practice.)
Normal echocardiogram (left ventricle at LV) Echocardiogram showing severe LVH
Figure 1: Normal echocardiogram (left ventricle at LV) Figure 2: Echocardiogram showing severe LVH

Treatment for LVH

If you have LVH, some things you can do include:

Quit smoking.
Tobacco use has been found to raise the risk of LVH by 42%. 2 If you smoke, stopping can help protect your heart. Can't do it alone? Ask your doctor about prescription drugs to help you.
Eat enough protein.
Low serum albumin levels seem to make LVH progress faster. 2,29,30 If you can't face protein, you may not be getting enough dialysis to keep up your appetite. Getting more treatment can help your heart.
Ask about angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors.
Some blood pressure drugs in these two classes have reversed LVH, including losartan (25% less LVH vs. placebo or other drugs)31,32, losartan plus enalapril (an extra 28% less LVH)33, valsartan 34, and imidapril 35.
Get bone disease treated.
Having too much parathyroid hormone 2 and/or not enough active vitamin D (calcitriol) makes LVH worse. Taking calcitriol has been shown to improve it, 36,37 so you can do both your bones and your heart a favor at the same time.


While LVH is quite common, it does not have to happen. There is much you can do to prevent LVH, slow it down, or even make it better. Talk with your doctor about tests for LVH so you know how your heart is doing. Ask how often these tests should be done.

If you have LVH, talk with your doctor about a treatment plan. You may also want to ask to see a heart specialist (cardiologist) to be sure that you get the help you need to feel your best.


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