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Published on: November 7, 2017
Chronic kidney disease-associated cardiomyopathy: clinical features, pathophysiology and treatment
Nicola C Edwards1,2,3, Davor Pavlovic4,5, Charles J Ferro4,5
1Birmingham Cardio-Renal Group, Queen Elizabeth Hospital, Birmingham, UK. nicolaed@adhb.govt.nz.
Insights
Chronic kidney disease (CKD) causes severe heart muscle disease, termed CKD-associated cardiomyopathy. Early intervention is key to preventing heart damage and reducing mortality in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Uraemic cardiomyopathy, characterized by left ventricular hypertrophy and fibrosis, is prevalent in kidney failure.
- Multiple hemodynamic and metabolic abnormalities in chronic kidney disease (CKD) contribute to myocardial damage.
- Cardiac dysfunction begins early in CKD, potentially around an estimated glomerular filtration rate of 60 ml/min/1.73 m².
Purpose of the Study:
- To propose the more accurate term 'CKD-associated cardiomyopathy'.
- To review clinical manifestations, imaging findings, causative factors, and treatments for this condition.
- To emphasize the need for understanding pathogenesis to develop preventive therapies.
Main Methods:
- Literature review of existing studies on uraemic cardiomyopathy and CKD.
- Analysis of clinical and imaging data related to cardiac abnormalities in CKD patients.
- Synthesis of information on etiological factors and therapeutic strategies.
Main Results:
- The term 'uraemic cardiomyopathy' is considered misleading; 'CKD-associated cardiomyopathy' is suggested.
- Cardiac abnormalities are present throughout CKD progression, not just in kidney failure.
- Multiple interacting factors contribute to the development and progression of the cardiomyopathy.
Conclusions:
- A shift in terminology to 'CKD-associated cardiomyopathy' is recommended for accuracy.
- Understanding the pathogenesis is crucial for developing effective preventive treatments.
- Reducing severe cardiomyopathy in kidney failure patients can decrease mortality.
Abstract:
Uraemic cardiomyopathy is a term widely used to describe the severe myocardial disease characterized by left ventricular hypertrophy and diffuse interstitial fibrosis that occurs in kidney failure. The causative factors are multiple and include many of the haemodynamic and metabolic abnormalities that are present in patients with chronic kidney disease (CKD). These abnormalities start to cause left ventricular damage and dysfunction in the early stages of CKD, probably from an estimated glomerular filtration rate of approximately 60 ml/min/1.73 m2. The term 'uraemic cardiomyopathy' is therefore misleading and inaccurate, and we suggest instead using the term 'CKD-associated cardiomyopathy'. In this Review, we describe the clinical manifestations and myocardial abnormalities seen on imaging in both CKD and kidney failure, discuss the multiple and interacting causative factors, and consider both established and prospective treatment options. A better understanding of the pathogenesis of CKD-associated cardiomyopathy is likely to lead to the introduction of effective preventive therapies, with success measured as a reduction in the proportion of patients reaching kidney failure with severe cardiomyopathy and ultimately in a reduction in the mortality from this condition.
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