Risk factors for diastolic left ventricular myocardial dysfunction in patients with chronic kidney disease
T E Rudenko1, E S Kamyshova1, M P Vasilyeva1
1I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
Insights
Diastolic dysfunction (DD) affects about 40% of chronic kidney disease (CKD) patients, increasing with renal dysfunction. Age and declining kidney function are key risk factors for DD in CKD.
Area of Science:
- Cardiology
- Nephrology
- Cardiorenal Medicine
Background:
- Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity.
- Diastolic dysfunction (DD) of the left ventricle (LV) is a common cardiac complication in CKD patients.
- Understanding the prevalence and risk factors for DD in CKD is crucial for patient management.
Purpose of the Study:
- To determine the frequency of left ventricular diastolic dysfunction (DD) in patients with chronic kidney disease (CKD).
- To identify risk factors associated with the development of DD in CKD patients.
- To explore the relationship between the severity of CKD and the incidence of DD.
Main Methods:
- A cohort of 225 non-diabetic CKD patients (stage I-IV) was studied, divided into three groups based on glomerular filtration rate (GFR).
- Transthoracic echocardiography was performed to assess cardiac function and structure.
- Clinical data, including age, body mass index (BMI), and fibrinogen levels, were collected. Cystatin C levels were measured in a subset of patients.
Main Results:
- Left ventricular hypertrophy (LVH) was observed in 38.7% of CKD patients.
- Diastolic dysfunction (DD) of the hypertrophic type (type I) was diagnosed in 41.4% of patients.
- The incidence of DD increased with decreasing GFR (30% in GFR 89-45, 40% in GFR 44-15, and 60% in GFR <15 ml/min/1.73 m2).
- Independent predictors for DD included older age (OR 1.106) and higher BMI.
- Patients with DD had higher BMI, lower GFR, and higher fibrinogen levels, with a higher likelihood of LVH.
Conclusions:
- Diastolic dysfunction (DD) is prevalent in approximately 40% of CKD patients, with its frequency escalating as renal dysfunction progresses.
- Cardiovascular risk factors such as advanced age and elevated BMI contribute to DD development in CKD.
- Declining glomerular filtration rate (GFR) and associated left ventricular (LV) remodeling are significant factors in the pathogenesis of DD in CKD patients.
Aim:
To examine the frequency and risk factors for the development of diastolic dysfunction (DD) of the left ventricle (LV) of the heart in patients with chronic kidney disease (CKD).
Materials And Methods:
The study included 225 patients with stage I-CKD of non-diabetic etiology (median age 47.0 years, 50.2% of women). Depending on the degree of decrease in the glomerular filtration rate (GFR), all patients were divided into 3 groups. Group 1 (n=70) consisted of patients with GFR 89-45 ml / min / 1.73 m2, group 2 (n=120) - patients with GFR 44-15 ml / min / 1.73 m2, group 3 (n=35) - patients with GFR <15 mL / min / 1.73 m2. The control group includes persons without CKD. All patients underwent general clinical examination and transthoracic echocardiography; in 86 patients the level of cystatin C in the blood serum was determined.
Results:
Hypertrophy of the left ventricle (LVH) of the heart was detected in 87 (38.7%) of 225 patients with CKD. Hypertrophic type (type I) of myocardial DD is diagnosed in 90 (41.4%) of 225 patients with CKD. The incidence of myocardial left ventricular dysfunction of the 1st type increased with a decrease in GFR, amounting to 30, 40 and 60% in groups 1, 2 and 3, respectively. The systolic function of the left ventricular myocardium was preserved. Patients with DD were older, they had a higher body mass index (BMI), a more pronounced decrease in GFR, a higher level of fibrinogen. They were more likely to have LVH. The level of cystatin C as the kidney function worsened, but when comparing the mean levels of cystatin C in patients with the presence / absence of DD in the groups isolated depending on the stage of CKD, no statistically significant differences were found. According to the multivariate analysis, the independent predictor of DD was the age (odds ratio 1.106, 95% confidence interval 1.051-1.157, p=0.00001).
Conclusion:
DD of the myocardium of the LV is detected on average in 40% of patients with CKD, the frequency of its development increases with the progression of renal dysfunction. The development of DD is influenced by traditional factors of cardiovascular risk (age, BMI), as well as the decline in GFR and closely related structural remodeling of LV myocardium.
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