Left ventricular dysfunction among chronic kidney disease patients: a cross sectional study
Keywords:Chronic kidney disease, Echocardiography, Left ventricular dysfunction
Background: There is a significant worldwide burden of CKD; which is likely to increase further. Cardiovascular diseases constitute major cause of morbidity and mortality in CKD. LV dysfunction may be present despite the asymptomatic phase during the early stages of CKD. Thus, early detection of LV dysfunction and targeted interventions can improve prognosis in CKD.
Methods: This cross-sectional study was conducted among 250 CKD admitted patients. Echocardiographic examination was done to determine the systolic and diastolic function of LV. For LV systolic function ejection fraction and % fractional shortening were calculated and for LV diastolic function E/A, E/E’, E deceleration time and IVRT were measured.
Results: Among 250 study subjects, 112 (47.8%) had systolic dysfunction and 138 (55.2%) had diastolic dysfunction. The prevalence of systolic as well as diastolic dysfunction increased significantly (P<0.05) with deteriorating renal function (39.1% for CKD stage 1 and 67.8% for stage 5 for systolic dysfunction, 34.8% for CKD stage 1 and 77.8% for stage 5 for diastolic dysfunction).
Conclusions: LV systolic and diastolic dysfunctions are significantly prevalent among CKD patients which increase with increasing severity of CKD. Hence, it is important to routinely screen these patients for LV dysfunction. The use of echocardiography can detect LV dysfunction at an early stage among the high-risk population of CKD to help plan appropriate strategies to slow the progression of cardiac dysfunction and improve prognosis.
Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, et al. global prevalence of chronic kidney disease: a systematic review and meta-analysis. PloS one. 2016;11(7):e0158765.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. New Eng J Medi. 2004;351(13):1296-305.
Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: Accuracy in good health and in chronic kidney disease. Annals Int Med. 2004;141(12):929-37.
Otsuka T, Suzuki M, Yoshikawa H, Sugi K. Left ventricular diastolic dysfunction in the early stage of chronic kidney disease. J Cardiol. 2009;54(2):199-204.
Kim MK, Kim B, Lee JY, Kim JS, Han BG, Choi SO, et al. Tissue Doppler-derived E/e' ratio as a parameter for assessing diastolic heart failure and as a predictor of mortality in patients with chronic kidney disease. Korean J Int Med. 2013;28(1):35-44.
Hida S, Chikamori T, Tanaka H, Igarashi Y, Hatano T, Usui Y, et al. Diagnostic value of left ventricular function after adenosine triphosphate loading and at rest in the detection of multi-vessel coronary artery disease using myocardial perfusion imaging. J Nuclear cardiol American Soc Nuclear Cardiol. 2009;16(1):20-7.
Martin FL, McKie PM, Cataliotti A, Sangaralingham SJ, Korinek J, Huntley BK, et al. Experimental mild renal insufficiency mediates early cardiac apoptosis, fibrosis, and diastolic dysfunction: a kidney-heart connection. Am J Physiol Regulatory, Integrative Comparative Physiol. 2012;302(2):R292-9.
Sato W, Kosaka T, Koyama T, Ishida M, Iino K, Watanabe H, et al. Impaired renal function is a major determinant of left ventricular diastolic dysfunction: assessment by stress myocardial perfusion imaging. Ann Nuclear Med. 2013;27(8):729-36.
Masugata H, Senda S, Goda F, Yamagami A, Okuyama H, Kohno T, et al. Echocardiographic assessment of the cardio-renal connection: is left ventricular hypertrophy or diastolic function more closely correlated with estimated glomerular filtration rate in patients with cardiovascular risk factors? Clinical Experiment Hypertension (New York, NY:1993). 2010;32(2):113-20.
Segall L, Nistor I, Covic A. Heart Failure in Patients with Chronic Kidney Disease: A Systematic Integrative Review. BioMed Res Int. 2014;2014:21.
Sood MM, Pauly RP, Rigatto C, Komenda P. Left ventricular dysfunction in the haemodialysis population. NDT plus. 2008;1(4):199-205.
Matsushita K, Mahmoodi BK, Woodward M, Emberson JR, Jafar TH, Jee SH, et al. Comparison of risk prediction using the CKD-EPI equation and the MDRD study equation for estimated glomerular filtration rate. Jama. 2012;307(18):1941-51.
Zhu Y, Ye X, Zhu B, Pei X, Wei L, Wu J, et al. Comparisons between the 2012 new CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equations and other four approved equations. PloS one. 2014;9(1):e84688.
Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825-30.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Journal of the American Society of Echocardiography: official publication of the Am Soc Echocardio. 2009;22(2):107-33.
Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Society Echocardio .2016;29(4):277-314.
Nitin R R, Malay K G, Shah H. Assessment of cardiac dysfunction by 2D echocardiography in patients of chronic kidney disease. JPBMS, Vol. 17(17). 2012.
Bullock RE, Hassem AA, Simpson I et al. Cardiac abnormalities and exercise tolerance in patients receiving renal replacement therapy. BMJ 1984;28:1479-84.
Franczyk-Skora B, Gluba A, Olszewski R, Banach M, Rysz J. Heart function disturbances in chronic kidney disease - echocardiographic indices. Archives of medical science: AMS. 2014;10(6):1109-16.
Singal KK, Singal N, Gupta P, Chander J, Relan P. Cardiac status in patients of chronic kidney disease: an assessment by non-invasive tools. Bang J Med Sci. 2016;15(2):207-15.
Debnath A, Chaudhury SR, Nath A. Echocardiographic assessment of left ventricular systolic dysfunction in chronic kidney disease patients of a rural tertiary medical care centre in West Bengal. IOSR J Dent Med Sci. 2014;13(1):69-73. .
Hayashi SY, Rohani M, Lindholm B, Brodin LA, Lind B, Barany P, et al. Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association: European Renal Assoc. 2006;21(1):125-32.
Losi MA, Memoli B, Contaldi C, Barbati G, Del Prete M, et al. Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis. Nephrology, Dialysis, Transplant. 2010;25(6):1950-4.
Agarwal S, Dangri P, Kalra O, Rajpal S. Echocardiographic assessment of cardiac dysfunction in patients of chronic renal failure. J Indian Acad Clin Med. 2003;4(4):297.
Cioffi G, Tarantini L, Faggiano P, Pulignano G, Russo G, Di Lenarda A. Left ventricular systolic dysfunction in chronic kidney disease: from asymptomatic changes in geometry and function to overt heart failure. Monaldi Archives Chest Dis. 2015;82(1):10-5.
Cioffi G, Tarantini L, Frizzi R, Stefenelli C, Russo TE, Selmi A, Toller C, Furlanello F, de Simone G. Chronic kidney disease elicits excessive increase in left ventricular mass growth in patients at increased risk for cardiovascular events. J Hypertens. 2011;29(3):565-73.
Laddha M, Sachdeva V, Diggikar PM, Satpathy PK, Kakrani AL. Echocardiographic assessment of cardiac dysfunction in patients of end stage renal disease on haemodialysis. J Assoc Physicians India. 2014;62(1):28-32.
Poorrafsanjani MH, Darabad BR. Evaluate the sensitivity and specificity echocardiography in trans-Doppler and tissue Doppler method in the estimation of left ventricular end-diastolic pressure. Global J Health Sci. 2014;6(7):92-7.
Isaaz K, Munoz del Romeral L, Lee E, Schiller NB. Quantitation of the motion of the cardiac base in normal subjects by Doppler echocardiography. J Am Society Echocardio. 1993;6(2):166-76.
Lee SW, Park MC, Park YB, Lee SK. E/E' ratio is more sensitive than E/A ratio for detection of left ventricular diastolic dysfunction in systemic lupus erythematosus. Lupus. 2008;17(3):195-201.