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Updated: Jul 12, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Diastolic function in chronic kidney disease
Giovanni de Simone1, Costantino Mancusi1
1Hypertension Research Center and Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Insights
Chronic kidney disease (CKD) involves abnormal heart muscle shape and function, leading to diastolic dysfunction. This review explores the causes and assessment of diastolic dysfunction in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Physiology
Background:
- Chronic kidney disease (CKD) is linked to distinct cardiac alterations, including concentric left ventricular (LV) geometry.
- This geometry is associated with impaired LV relaxation and increased myocardial stiffness, key indicators of diastolic dysfunction.
- Non-hemodynamic factors like metabolic disturbances and inflammatory pathways also contribute to myocardial structural changes in CKD.
Purpose of the Study:
- To review the pathophysiology of diastolic dysfunction in CKD.
- To examine the interplay between cardiac mechanics, hemodynamics, structural changes, and metabolic factors in CKD-related diastolic dysfunction.
- To discuss methods for quantifying diastolic function and its clinical significance in CKD.
Main Methods:
- Literature review focusing on the pathophysiology of diastole in CKD.
- Analysis of mechanisms including elastic recoil, active relaxation, and passive filling.
- Discussion of current methods for assessing diastolic function.
Main Results:
- CKD is characterized by age-independent concentric LV geometry, systolic dysfunction, and diastolic dysfunction.
- Abnormal LV relaxation and myocardial stiffness are consistently observed in CKD.
- Non-hemodynamic factors significantly impact myocardial structure and function, contributing to diastolic impairment.
Conclusions:
- Diastolic dysfunction is a prominent feature in CKD, influenced by both hemodynamic and non-hemodynamic factors.
- Understanding the mechanisms of diastolic dysfunction is crucial for managing cardiovascular complications in CKD.
- Further research is needed to clarify whether diastolic dysfunction is a distinct feature or a marker of cardiovascular severity in CKD.
Abstract:
Chronic kidney disease (CKD) is characterized by clustered age-independent concentric left ventricular (LV) geometry, geometry-independent systolic dysfunction and age and heart rate-independent diastolic dysfunction. Concentric LV geometry is always associated with echocardiographic markers of abnormal LV relaxation and increased myocardial stiffness, two hallmarks of diastolic dysfunction. Non-haemodynamic mechanisms such as metabolic and electrolyte abnormalities, activation of biological pathways and chronic exposure to cytokine cascade and the myocardial macrophage system also impact myocardial structure and impair the architecture of the myocardial scaffold, producing and increasing reactive fibrosis and altering myocardial distensibility. This review addresses the pathophysiology of diastole in CKD and its relations with cardiac mechanics, haemodynamic loading, structural conditions, non-haemodynamic factors and metabolic characteristics. The three mechanisms of diastole will be examined: elastic recoil, active relaxation and passive distensibility and filling. Based on current evidence, we briefly provide methods for quantification of diastolic function and discuss whether diastolic dysfunction represents a distinct characteristic in CKD or a proxy of the severity of the cardiovascular condition, with the potential to be predicted by the general cardiovascular phenotype. Finally, the review discusses assessment of diastolic function in the context of CKD, with special emphasis on end-stage kidney disease, to indicate whether and when in-depth measurements might be helpful for clinical decision making in this context.
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