Related Experiment Video
Updated: Sep 28, 2025
A Mouse 5/6th Nephrectomy Model That Induces Experimental Uremic Cardiomyopathy
Published on: November 7, 2017
Abnormalities in Cardiac Structure and Function among Individuals with CKD: The COMBINE Trial
Ann A Wang1, Xuan Cai2, Anand Srivastava2,3
1Graduate Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Insights
Individuals with chronic kidney disease (CKD) show cardiac abnormalities. Higher albuminuria is linked to diastolic dysfunction in CKD patients, regardless of existing cardiovascular disease (CVD).
Area of Science:
- Nephrology
- Cardiology
- Biomarkers
Background:
- Chronic kidney disease (CKD) significantly increases the risk of cardiovascular disease (CVD).
- Subclinical CVD in CKD patients can be detected using cardiac magnetic resonance imaging (cMRI).
Purpose of the Study:
- To compare cMRI parameters between CKD patients and healthy controls.
- To investigate associations between CKD biomarkers and cMRI findings.
Main Methods:
- cMRI was performed on 140 individuals with CKD stages 3b-4 and 24 healthy volunteers.
- Associations between eGFR, UACR, phosphate, FGF23, PTH, and cMRI parameters were analyzed cross-sectionally and longitudinally.
Main Results:
- CKD patients exhibited lower mitral valve E/A ratio compared to controls.
- Higher urine albumin-creatinine ratio (UACR) was independently associated with lower mitral valve E/A ratio in CKD patients.
- No significant associations were found between eGFR, phosphate, FGF23, PTH, and cMRI parameters.
Conclusions:
- CKD stages 3b-4 are associated with cardiac structural and functional abnormalities detected by cMRI.
- Albuminuria is an independent predictor of diastolic dysfunction in CKD patients.
- Albuminuria did not predict changes in cMRI parameters over 12 months.
Background:
Individuals with CKD have a high burden of cardiovascular disease (CVD). Abnormalities in cardiac structure and function represent subclinical CVD and can be assessed by cardiac magnetic resonance imaging (cMRI).
Methods:
We investigated differences in cMRI parameters in 140 individuals with CKD stages 3b-4 who participated in the CKD Optimal Management with BInders and NicotinamidE (COMBINE) trial and in 24 age- and sex-matched healthy volunteers. Among COMBINE participants, we examined the associations of eGFR, urine albumin-creatinine ratio (UACR), phosphate, fibroblast growth factor 23 (FGF23), and parathyroid hormone (PTH) with baseline (N=140) and 12-month change (N=112) in cMRI parameters.
Results:
Mean (SD) ages of the COMBINE participants and healthy volunteers were 64.9 (11.9) and 60.4 (7.3) years, respectively. The mean (SD) baseline eGFR values in COMBINE participants were 32.1 (8.0) and 85.9 (16.0) ml/min per 1.73 m2 in healthy volunteers. The median (interquartile range [IQR]) UACR in COMBINE participants was 154 (20.3-540.0) mg/g. Individuals with CKD had lower mitral valve E/A ratio compared with healthy volunteers (for CKD versus non-CKD, β estimate, -0.13; 95% CI, -0.24 to -0.012). Among COMBINE participants, multivariable linear regression analyses showed that higher UACR was significantly associated with lower mitral valve E/A ratio (β estimate per 1 unit increase in natural-log UACR, -0.06; 95% CI, -0.09 to -0.03). This finding was preserved among individuals without baseline CVD. UACR was not associated with 12-month change in any cMRI parameter. eGFR, phosphate, FGF23, and PTH were not associated with any cMRI parameter in cross-sectional or change analyses.
Conclusions:
Individuals with CKD stages 3b-4 have evidence of cMRI abnormalities. Albuminuria was independently associated with diastolic dysfunction, as assessed by mitral valve E/A ratio, in individuals with CKD with and without clinical CVD. Albuminuria was not associated with change in any cMRI parameter.
Related Concept Videos
01:24Chronic Kidney Disease II: Clinical Manifestations
01:18Chronic Kidney Disease IV: Nursing Management
01:25Chronic Kidney Disease I: Introduction
01:28Chronic Kidney Disease III: Interprofessional Care
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:29Acute Kidney Injury II: Pathophysiology