Left Atrial Dysfunction in End-Stage Kidney Disease: Improvement After Transplantation and Relation to Exercise...

Stroke and atrial fibrillation are frequent manifestations of left atrial (LA) myopathy in patients with end-stage kidney disease (ESKD). However, the natural history of LA dysfunction and its reversibility following renal transplantation remain insufficiently defined. We aimed to assess baseline LA function and post-transplantation changes in ESKD using LA emptying fraction (LAEF) and LA function index (LAFI).

A total of 111 patients with ESKD listed for renal transplantation and 45 healthy controls were enrolled. All participants underwent two-dimensional echocardiography and treadmill exercise testing at baseline and at 6 months. Patients who did not undergo transplantation during follow-up continued maintenance hemodialysis.

At baseline, LA volumes were significantly increased in patients with ESKD regardless of whether they were on hemodialysis; however, no significant difference in LAEF was observed between groups (p = 0.073). Compared to the control group, the hemodialysis cohort exhibited a significantly higher prevalence of elevated LA pressure (p < 0.001) and a reduced LAFI (p = 0.001), and LAFI remained significantly lower in the hemodialysis group following multivariable adjustment. Six months after transplantation, transplant recipients had significantly higher LAEF and LAFI compared to patients remaining on hemodialysis (adjusted P_int = 0.013 and 0.045). Both LAEF and LAFI correlated positively with exercise capacity at baseline, and longitudinal improvement in LAFI correlated with improved exercise duration at follow-up.

LA function is impaired in ESKD, particularly among patients on dialysis, and is associated with reduced exercise capacity. Renal transplantation is linked to relative preservation and modest improvement of LA function, paralleling better functional performance.