Table 1.

Considerations for LVH as a Therapeutic Target in ESRD
Pro
High prevalence
Strong (univariate) associates of baseline LVH with all-cause mortality and CV events
Independent associations of LVMI progression with survival
Treatable risk factor—demonstrated reversibility in randomized angiotensin blockade studies and frequent dialysis studies
Multiple underlying pathways provide multiple targets for therapeutic intervention
Easy to measure-echocardiography is non-invasive and widely available
Con
Uncertain whether an independent/causal risk factor
LVH not established as a reliable surrogate outcome measure in ESRD—studies demonstrating associations of randomized change in LVMI with outcomes are lacking
Optimal therapeutic maneuvers and targets (e.g. goal blood pressure) undefined
Volume dependence of LVH measurement31—optimal timing of LVH relative to dialytic schedule uncertain
Ideal interval between repeated assessments undefined

LVH-left ventricular hypertrophy. LVMI-left ventricular mass index. CV-cardiovascular