Left ventricular mass progression despite stable blood pressure and kidney function in stage 3 chronic kidney disease

Area of Science:

• Nephrology and Cardiology
• Biomarkers and Cardiovascular Risk

Background:

• Chronic kidney disease (CKD) is linked to increased cardiovascular (CV) risk, often unexplained by traditional factors.
• Left ventricular hypertrophy (LVH) is a significant CV risk factor, but its progression in early CKD is understudied.

Purpose of the Study:

• To investigate the progression of LVH in patients with stage 3 CKD over 12 months.
• To determine if LVH progression occurs despite stable kidney function and blood pressure.

Main Methods:

• A post hoc analysis of a 12-month study involving patients with stage 3 CKD.
• Longitudinal assessment of cardiovascular biomarkers, including left ventricular mass indexed to height (LVM/Ht(2.7)), blood pressure, pulse-wave velocity, LV systolic/diastolic function, FGF23, and klotho.
• Primary outcome was change in LVM/Ht(2.7).

Main Results:

• Left ventricular mass indexed to height (LVM/Ht(2.7)) significantly increased over 12 months (p = 0.006).
• This increase occurred despite stable blood pressure, stable estimated glomerular filtration rate (eGFR), and normal LV systolic function.
• Vascular stiffness and LV diastolic dysfunction persisted; klotho levels decreased, and the FGF23/klotho ratio correlated with LVM/Ht(2.7) changes (r2 = 0.582, p = 0.03).

Conclusions:

• Patients with stage 3 CKD experience increasing left ventricular mass and persistent diastolic dysfunction and vascular stiffness, even with stable kidney function and blood pressure.
• Abnormal fibroblast growth factor 23 (FGF23) signaling, potentially due to reduced klotho expression, may contribute to the progression of left ventricular mass.