Hemodialysis patients have low 5-year survival rates of approximately 60%, and the most common cause of death is
cardiovascular diseases. Their population may be considered, therefore, as an accelerated model in analyzing the risk factors for
cardiovascular diseases. We previously reported the role of blood pressure, one of the most important risk factors for
cardiovascular diseases, in determining the prognosis of
hemodialysis patients. In this study, we examined the effect of
cardiomegaly detected on chest roentgenogram or electrocardiogram before initiating
hemodialysis therapy on survival after introduction to maintenance
hemodialysis. One hundred and sixty
hemodialysis patients who had no history of
ischemic heart disease or
arrhythmia were followed up for 88.9 +/- 4.0 months, among whom 69 died.
Heart enlargement, defined on chest roentgenogram, was detected in 104 patients, and
left ventricular hypertrophy, defined on electrocardiogram, was detected in 105 patients. The presence of either finding shortened their survival. However, Cox's proportional hazards model and logistic multiple regression analysis identified only
left ventricular hypertrophy as one of the significant determinants for survival, but
heart enlargement was not independent. Correction of
systolic hypertension on the maintenance phase had no significant favorable effect on survival in patients with
left ventricular hypertrophy, while it improved in those with
heart enlargement. This finding, together with those above from Cox's model and logistic analysis strongly suggests that risk from
left ventricular hypertrophy is independent of, but one from
heart enlargement is dependent on
hypertension.