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Updated: Jul 4, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Cardiac Magnetic Resonance Imaging Findings in Patients With Chronic Kidney Disease and End-Stage Kidney Disease: A
Deepak Chandramohan1, Rhoshini Rajasekaran2, Raghunandan Konda1
1Nephrology, University of Alabama at Birmingham, Birmingham, USA.
Insights
Cardiac magnetic resonance imaging (CMR) detects fibrotic changes in chronic kidney disease (CKD) and end-stage kidney disease (ESKD). T1 mapping reveals increased cardiac mass and fibrosis, aiding early cardiomyopathy detection.
Area of Science:
- Cardiology
- Nephrology
- Radiology
- Biomedical Engineering
Background:
- Uremic cardiomyopathy, characterized by myocardial fibrosis, is a significant complication in chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
- Early detection of fibrotic changes is crucial for managing potential complications like arrhythmia and heart failure.
- Cardiac magnetic resonance imaging (CMR) offers a noninvasive method to assess cardiac remodeling and fibrosis.
Purpose of the Study:
- To systematically review and meta-analyze the utility of cardiac magnetic resonance imaging (CMR) in detecting fibrotic changes in patients with CKD and ESKD.
- To evaluate the association between CMR-derived parameters and the severity of uremic cardiomyopathy.
- To assess the role of T1 mapping in quantifying myocardial fibrosis in these patient populations.
Main Methods:
- A comprehensive systematic search of electronic databases was performed to identify relevant studies.
- Studies were categorized based on scanner field strength (1.5T or 3T).
- A random-effects model was employed for meta-analysis, calculating pooled means, confidence intervals, and standardized mean differences (SMD), with heterogeneity assessed using the I2 statistic.
Main Results:
- The meta-analysis included 20 studies with 642 CKD patients and 658 ESKD patients on dialysis.
- Both CKD and ESKD patients exhibited increased left ventricular mass index (LVMi) compared to controls (SMD 0.37 and 0.88, respectively).
- T1 mapping revealed elevated native septal T1 values in both CKD and ESKD patients compared to controls (SMD 1.099 and 1.12, respectively), indicating myocardial fibrosis.
Conclusions:
- Patients with CKD and ESKD, even with preserved left ventricular ejection fraction (LVEF), demonstrate increased left ventricular mass and myocardial fibrosis as indicated by higher LVMi and T1 values.
- T1 mapping is a valuable tool for the early detection of cardiomyopathy and risk stratification in CKD and ESKD patients.
- Further large-scale randomized trials are warranted to confirm these findings and investigate the long-term impact of dialysis on cardiac fibrosis.
Abstract:
In this systematic review and meta-analysis, we explored the utilization of cardiac magnetic resonance imaging (CMR) to detect fibrotic changes secondary to uremic cardiomyopathy during the early stages of chronic kidney disease (CKD) and in patients with end-stage kidney disease (ESKD). Uremic myocardial fibrosis can lead to arrhythmia and heart failure, and it is important to detect these changes. CMR offers a noninvasive way to characterize the severity of cardiac remodeling. A comprehensive search of multiple electronic databases was conducted. Studies were divided according to scanner field strength (1.5 or 3 Tesla). The random effects model was used to calculate the pooled mean, 95% confidence interval (CI), standard error, and standardized mean difference (SMD). The I2 statistic was used to assess the heterogeneity between study-specific estimates. The search retrieved 779 studies. From these, 20 studies met the inclusion criteria and had 642 CKD patients (mean age of 56.8 years; 65.2% males; mean estimated glomerular filtration rate (eGFR) of 33 mL/min/1.73 m2) and 658 ESKD patients on dialysis (mean age of 55.6 years; 63.3% males; mean dialysis duration of 3.47 years). CKD patients had an increased left ventricular mass index (LVMi) compared to controls, with an SMD of 0.37 (95% CI: 0.20-0.54; I2 0%; p-value <0.05). ESKD patients also had increased LVMi compared to controls, SMD 0.88 (95% CI: 0.35-1.41; I2 79.1%; p-value 0.001). Myocardial fibrosis assessment using T1 mapping showed elevated values; the SMD of native septal T1 values between CKD and controls was 1.099 (95% CI: 0.73-1.46; I2 33.6%; p-value <0.05), and the SMD of native septal T1 values between ESKD patients and controls was 1.12 (95% CI: 0.85-1.38; I2 33.69%; p-value <0.05). In conclusion, patients with CKD and ESKD with preserved left ventricular ejection fraction (LVEF) have higher LVMi and T1 values, indicating increased mass and fibrosis. T1 mapping can be used for the early detection of cardiomyopathy and as a risk stratification tool. Large, randomized trials are needed to confirm these findings and determine the effect of long-term dialysis on cardiac fibrosis.
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