Pressure-overload cardiomyopathy in end-stage renal disease

Left ventricular Hypertrophy is the most frequent alteration in ESRD and is an independent risk factor for survival. Left Ventricular Hypertrophy is an 'adaptive' response to increase in cardiac work that results in ESRD patients from increased stroke volume and high-output state (flow/volume overload, an increased opposition to left ventricular ejection (pressure overload), and an increased heart rate. Pressure overload is determined by peripheral resistance, arterial stiffness and elevated arterial inertance, while peripheral resistance is usually within the normal values. Increased arterial stiffness and inertance are associated with remodelling of large arteries which are dilated and hypertrophied, Arterial hypertrophy is accompanied by alterations of the intrinsic elastic properties of arterial walls that contribute to amplify the pressure load. Curr Opin Nephrol Hypertens 8:179-186. (C) 1999 Lippincott Williams & Wilkins.