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Left Ventricular Mass is Associated with Biopsy-Assessed Renal Fibrosis in Chronic Kidney Disease
Carl G Glessgen1, Aurélie Huber2, Lindsey A Crowe1
1Diagnostic Department, Division of Radiology, University Hospitals of Geneva, Geneva, Switzerland.
Insights
In chronic kidney disease (CKD) patients, increased left ventricular mass is linked to renal interstitial fibrosis, independent of kidney function. This suggests structural kidney damage offers insights beyond estimated glomerular filtration rate (eGFR).
Area of Science:
- Cardiology
- Nephrology
- Biomarkers
Background:
- Left ventricular remodeling is a predictor of cardiovascular mortality in chronic kidney disease (CKD).
- Previous research linked renal function markers to cardiac structural changes, but the relationship between cardiac MRI parameters and renal interstitial fibrosis is not well understood.
- This study investigated the association between cardiac remodeling and biopsy-proven renal interstitial fibrosis in CKD patients.
Purpose of the Study:
- To investigate the association between cardiac remodeling, assessed by cardiac MRI, and biopsy-assessed renal interstitial fibrosis in patients with CKD.
- To determine if cardiac structural changes correlate with the degree of renal interstitial fibrosis.
- To explore the independent association of cardiac remodeling with renal fibrosis beyond kidney function markers like eGFR.
Main Methods:
- Prospective single-center cohort study of CKD patients with native kidneys.
- Simultaneous cardiac MRI and renal biopsy performed within the same week.
- Renal interstitial fibrosis quantified as a percentage of affected cortex area.
- Cardiac parameters analyzed included left ventricular mass index (LVMi), left ventricular end-diastolic volume index (LVEDVi), global longitudinal strain (GLS), global circumferential strain (GCS), and myocardial T1.
- Associations assessed using Spearman correlations and multivariable linear regression adjusted for age and eGFR.
Main Results:
- Forty-seven CKD patients were included (median age 49 years, 55% male).
- Left ventricular mass index (LVMi) showed a significant correlation with renal fibrosis (ρ = 0.49; p < 0.001).
- Renal fibrosis remained associated with LVMi after adjustment for age and eGFR (β = 0.33; p < 0.001).
- The association between LVMi and renal fibrosis persisted even after excluding patients with high LVMi or high fibrosis grades.
Conclusions:
- Left ventricular mass is associated with biopsy-assessed renal interstitial fibrosis in CKD patients, independent of eGFR.
- Structural renal injury provides prognostic information beyond kidney function alone.
- The link between renal fibrosis and left ventricular remodeling is not fully explained by volume-related hemodynamic factors, as the association was only partially attenuated after adjusting for LV volume.
Background:
Left ventricular remodeling predicts cardiovascular mortality in chronic kidney disease (CKD). Prior studies have linked renal functional markers to cardiac structural changes, but the direct relationship between cardiac MRI parameters and renal interstitial fibrosis remains uncharacterized. We aimed to investigate the association between cardiac remodeling and biopsy-assessed renal interstitial fibrosis in patients with CKD.
Materials & Methods:
This prospective single-center cohort included CKD patients with native kidneys who underwent same-week cardiac MRI and renal biopsy. Renal interstitial fibrosis was quantified as a percentage of the affected cortex area. Five cardiac parameters were selected: LVMi, LVEDVi, GLS, GCS, and myocardial T1. Associations with renal fibrosis were assessed using Spearman correlations, and multivariable linear regression adjusted for age and estimated glomerular filtration rate (eGFR). Sensitivity analyses were performed after excluding outliers.
Results:
Forty-seven patients were included (median age, 49 years; 55% male). LVMi correlated with renal fibrosis (ρ = 0.49; p < 0.001). GLS (ρ = 0.33; p = 0.03) and GCS (ρ = 0.30; p = 0.04) showed consistent trends that did not survive statistical correction. Renal fibrosis remained associated with LVMi after adjustment for age and eGFR (β = 0.33; p < 0.001). Adding LVEDVi attenuated the fibrosis coefficient by 22% (β = 0.26; p < 0.001). The renal fibrosis - left ventricular mass association persisted after excluding patients with high LVMi or high fibrosis grades (ρ = 0.45, p = 0.002; ρ = 0.35, p = 0.026, respectively).
Conclusion:
In CKD patients, LV mass was associated with biopsy-assessed renal fibrosis, independently of eGFR, suggesting that structural renal injury provides information beyond kidney function alone. This association was only partially attenuated after adjustment for LV volume, indicating that volume-related hemodynamic factors may not fully account for the link between renal fibrosis and LV remodeling.
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