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Updated: Dec 15, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Patients with moderate chronic kidney disease without heart disease have reduced coronary flow velocity reserve
Pavlos Kashioulis1, Cecilia Wallentin Guron1, Maria K Svensson2
1Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Chronic kidney disease (CKD) patients show early heart abnormalities and coronary microvascular dysfunction (CMD). These findings suggest microvascular issues contribute to heart failure in CKD.
Area of Science:
- Cardiology
- Nephrology
- Cardiorenal Medicine
Background:
- Chronic kidney disease (CKD) is associated with increased cardiovascular risk.
- Sub-clinical cardiac abnormalities are common in CKD patients but often overlooked.
Purpose of the Study:
- To identify sub-clinical cardiac abnormalities using echocardiography in patients with CKD stages 3-4.
- To investigate the underlying mechanisms, including coronary microvascular dysfunction (CMD).
Main Methods:
- Cross-sectional study of 91 CKD patients (stages 3-4) and 41 controls.
- Doppler echocardiography assessed cardiac morphology and function.
- Coronary flow velocity reserve (CFVR) measured to detect CMD.
Main Results:
- CKD patients exhibited increased left atrial volume index and prolonged LV isovolumetric relaxation time.
- Significantly reduced CFVR in CKD patients (2.74 ± 0.86) vs. controls (3.40 ± 0.89).
- 43% of CKD patients had CMD compared to 9% of controls.
Conclusions:
- CKD stages 3-4 patients display early LV diastolic dysfunction, not meeting current criteria for overt dysfunction.
- A high prevalence of CMD in CKD patients suggests a pathogenic role in heart failure development.
Aims:
The overall aim was to identify sub-clinical cardiac abnormalities by echocardiography in patients with chronic kidney disease (CKD) stages 3 and 4 and to investigate underlying mechanisms.
Methods And Results:
Ninety-one patients with CKD stages 3 and 4, without a diagnosis of heart disease, and 41 healthy matched controls were included in this cross-sectional study. Cardiac morphology and function were analysed with Doppler echocardiography and coronary flow velocity reserve (CFVR) in response to adenosine was measured in the left anterior descendent artery to detect coronary microvascular dysfunction (CMD). All study subjects had a left ventricular (LV) ejection fraction > 50%. Patients with CKD showed statistically significant increases in left atrial volume index and transmitral and pulmonary vein flow velocities during atrial contraction and prolonged LV isovolumetric relaxation time. Patients with CKD had significantly reduced CFVR vs. controls (2.74 ± 0.86 vs. 3.40 ± 0.89, P < 0.001), and 43% of patients were classified as having CMD compared with 9% of controls (P = 0.001).
Conclusions:
Patients with CKD stages 3 and 4, without a diagnosis of heart disease, showed early abnormalities in LV diastolic function that did not fulfil the criteria for LV dysfunction according to current guidelines. A large proportion of CKD patients had CMD, suggesting that microvascular abnormalities may have a pathogenic role in the development of heart failure in this patient group.
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