A longitudinal study of left ventricular function and structure from CKD to ESRD: the CRIC study

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Abnormal left ventricular structure and function are linked to adverse outcomes in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD).
• Understanding changes in left ventricular mass and ejection fraction during the CKD to ESRD transition is crucial for improving cardiac outcomes.

Purpose of the Study:

• To investigate changes in left ventricular mass index and ejection fraction in patients transitioning from advanced CKD to ESRD.
• To identify potential factors influencing cardiac remodeling and function during the progression of kidney disease.

Main Methods:

• Longitudinal study of a subset of the Chronic Renal Insufficiency Cohort (CRIC) study participants.
• Serial echocardiograms were performed in patients with advanced CKD (eGFR < 20 mL/min/1.73 m²) and after ESRD diagnosis (initiation of dialysis).
• Data collected between 2003 and 2011.

Main Results:

• 190 participants (44% female, 66% Black) completed serial echocardiograms.
• No significant change in left ventricular mass index (LVMI) was observed between advanced CKD and ESRD (62.3 vs. 59.5 g/m²·⁷, P=0.10).
• Ejection fraction significantly decreased from 53% to 50% (P=0.002) during the transition from advanced CKD to ESRD.

Conclusions:

• Left ventricular mass index is relatively stable in advanced stages of CKD and into ESRD.
• A significant decline in ejection fraction occurs during the transition from advanced CKD to ESRD.
• The decrease in ejection fraction may contribute to increased cardiovascular disease and mortality risk in patients on dialysis.