Elevated systolic BP has a continuous, graded, and independent association with risk of coronary heart

disease, stroke, and ESKD [21]. LVH selleck inhibitor might be a beneficial compensatory process in CKD patients, allowing the left ventricle to produce additional force to increase cardiac work and maintain constant wall tension [22]. Even though mean systolic BP was well controlled (132.4 ± 18.1 mmHg), systolic BP was higher in patients with LVH than in patients without LVH in the present study. According to multivariate logistic regression analysis, systolic BP was an independent variable associated with LVH. Recently, it was reported that systolic arterial hypertension and elevated pulse pressure are closely associated with LVH in pre-dialysis patients, suggesting that fluid overload and increased arterial stiffness play important roles in LVH before starting dialysis therapy [12]. Fluid volume management and maintenance of a near euvolemic state are crucial for the amelioration of LVH [23]. After adjusting for several potential confounders, multivariate logistic regression analyses showed that the presence of a previous

CVD was significantly associated with LVH. The potential explanations for how the CKD state can accelerate atherosclerosis Tofacitinib price and cause CVD have been of considerable interest in clinical practice. The 4 basic explanations are: (1) uncontrolled confounding, or the impact of comorbidities that occur in CKD patients, especially older age; (2) therapeutic nihilism, meaning CKD patients receive lesser degrees of cardioprotective therapies; (3) excess treatment toxicities, intolerances, or risks such that therapy cannot be used or offers a less favorable Selleck Pazopanib benefit-to-risk ratio; and (4) a unique vascular pathobiology that occurs in the CKD state [24]. By using the large sample size of the Kidney Early Evaluation Program (KEEP), McCullough

et al. [25] demonstrated in stratified analysis that the presence of CKD in young adults was clearly related to premature CVD. These findings suggest the biological changes that occur with CKD promote CVD at an accelerated rate that cannot be fully explained by conventional risk factors or older age. In accordance with the theory of non-hemodynamic LVH-promoting factors in our CKD patients, BMI was found to be a factor that was independently associated with LVH. Obesity is thought to be a risk factor independent of LVH, and heart disorders in obesity include structural adaptation with LVH and functional abnormalities [26]. Kotsis et al. [27] reported that obesity and daytime pulse pressure are predictors of LVH in true normotensive individuals.