Cardiac function’s in patients with chronic kidney disease

Authors

  • Rajesh Roy Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India
  • Bhagirath Solanki Department of Medicine, B. J. Medical College, Ahmedabad, Gujarat, India
  • Niraj Chawda Department of Medicine, SBKS Medical Institute and Research Centre, Piperiya, Gujarat, India
  • Suresh Jain Department of Medicine, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
  • Chetan Sonkar Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India
  • Prashastee Patel Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India
  • Jui Patel Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India
  • Heer Pandit Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India
  • Nikunj Vanpariya Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India
  • Tejas Radadiya Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India
  • Amal Kumar Bhattacharya Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20223402

Keywords:

CKD, Dysfunction, Echocardiography, Hypertension

Abstract

Background: To assess the cardiac functions in patients with chronic kidney disease (CKD).

Methods: 150 patients with CKD were randomly selected. 12 lead ECG were performed to detect CVD. All Patients were diagnosed with CKD. The left ventricular ejection fraction (LVEF) and fractional shortening (FS) were taken as measures of LV systolic function. Diastolic function was determined by measuring early to late peak velocities (E/A) ratio by spectral Doppler LV inflow velocity.

Results: Male: female 95 and 55, hypertension 67% was leading cause of CKD. Diastolic dysfunction as denoted by E/A ratio of less than 0.75 or more than 1.8 was present in 64% of patients. Regional wall motion abnormality (RWMA) was present in 14%. LVH was present in 74%. Systolic dysfunction as measured by reduced fractional shortening (<25%) and decreased LVEF (<52%) was present in 8% and 12% respectively. PE was noted in 15% of patients. Valvular calcification in 8% of CKD patients. Mean LV internal diameter in diastole was 41±6 mm. Mean Interventricular septum diameters in systole was11.9±1.21 mm. Mean LA diameter was 29±4 mm. Statistically significant difference was noted in LVH and E/A ratio in hypertensive group as compared to normotensive group.

Conclusions: LV diastolic dysfunction also happens in patients who having the early stage of CKD. Hypertensive patients along with CKD had found higher widespread presence of diastolic and systolic dysfunction as compared to normotensive.

Author Biographies

Rajesh Roy, Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India

Associate Professor

Bhagirath Solanki, Department of Medicine, B. J. Medical College, Ahmedabad, Gujarat, India

Professor

Niraj Chawda, Department of Medicine, SBKS Medical Institute and Research Centre, Piperiya, Gujarat, India

Associate Professor

Suresh Jain, Department of Medicine, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India

Assistant Professor

Chetan Sonkar, Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India

Sr. Research Associate

Prashastee Patel, Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India

Interns

Jui Patel, Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India

Intern

Heer Pandit, Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India

Intern

Nikunj Vanpariya, Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India

Senior Resident

Tejas Radadiya, Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India

Senior Resident

Amal Kumar Bhattacharya, Department of Medicine, Parul Institute of Medical Sciences and Research (PIMSR), Parul Sevashram Hospital, Parul University, Limda, Waghodia, Vadodara, Gujarat, India

Professor and Head of the Department

References

Chronic Kidney Disease Prognosis Consortium. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. The Lancet. 2010;375(9731):2073-81

Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389:1238-52.

Van der Velde M, Matsushita K, Coresh J. Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality: a collaborative meta-analysis of high-risk population cohorts. Kidney Int. 2011;79:1341-52.

Cockwell P, Fisher LA. The global burden of chronic kidney disease. Lancet. 2020;395(10225):662-4.

Prevalence of CKD in the world. Available at: https://www.google.com/search?qGBIN867IN867& source=lnms&tbm=isch&sa=X&ved=2ahUKEwip7tD49fHxAhUpxTgGHU98CacQ_AUoAXoECAEQA PLM&imgdii=LFbcwZiJxjevKM. Accessed on 26 October 2022.

Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: core curriculum 2019. Am J Kidney Dis. 2019;19.

World Health Organization ISo HWG. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21(11):1983-92.

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2224-60.

Barri Y. Hypertension and kidney disease: a deadly connection. Curr Hypertens Rep. 2008;10:39-45.

Graeme Turner KW, Johnson D. Primary prevention of chronic kidney disease: blood pressure targets: chronic kidney disease guidelines. KHA-CARI guidelines: KHA. 2012.

Australian Institute of Health and Welfare. Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: risk factors. Cardiovascular, diabetes and chronic kidney disease series no 4 cat no CDK 4. Canberra: AIHW. 2015.

Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: a review. JAMA. 2019;322:1294-304.

WHO. Global NCD target: reduce high blood pressure, 2016. Available at: https://www.who.int/publications/i -reduce-high-blood-pressure. Accessed on 26 October 2022.

Wing AJ. Cardiovascular related causes of death and fate of patients with renovascular disease. Contributions Nephrol. 1984;41:306-11.

Bundy JD, Chen J, Yang W, Budoff M, Go AS, Grunwald JE et al. Risk factors for progression of coronary artery calcification in patients with chronic kidney disease: the CRIC study. Atherosclerosis. 2018;271:53-60.

Lees JS, Mark PB, Jardine AG. Cardiovascular complications of chronic kidney disease. Medicine. 2015;43(8):469-73

Silverberg JS, Sniderman AD, Barre PE, Prichard SS. Impact of left ventricular hypertrophy on survival in end stage renal disease. Kidney Int. 1989;36:286-90.

Laddha M, Sachdeva V, Diggikar PM, Satpathy PK, Kakrani AL. Echocardiographic assessment of cardiac dysfunction in patients of end stage renal disease on hemodialysis. J Assoc Physicians India. 2014;62(1):28-32.

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296-305.

Jardine AG, Gaston RS, Fellstrom BC, Holdaas H. Prevention of cardiovascular disease in adult recipients of kidney transplants. Lance.t 2011;378:1419e27.

Stone NJ, Robinson JG, Lichtenstein AH. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2889-934.

Sachdeva S, Khurana T, Kaur S, Aggarwal R, Kaur A, Singh B. ECG and ECHO Changes in CKD. Ann Int Med Dent Res. 2017;3(5):10-4.

Krishna M, Jindal A, Das S. A Study of Clinical Profile in Chronic Kidney Disease with Special Reference to Echo and Electrocardiography. J Med Sci. 2018;4(1):5-9.

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;62:28-33.

Singal KK, Singal N, Gupta P, Chander J, Relan P. Cardiac status in patients of chronic kidney disease: an assessment by non-invasive tools. Bangl J Med Sci. 2016;15(2): 207-15.

Rao T, Karwa M, Wanjari A. Left ventricular dysfunction among chronic kidney disease patients: a cross sectional study. Int J Adv Med. 2018;5:1093-9.

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.

Agrawal 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

Nitin RR, Malay KG, Shah H. Assessment of cardiac dysfunction by 2D echocardiography in patients of chronic kidney disease. JPBMS. 2012;17(17).

Singh S, Aggarwal V, Pandey UK, Sreenidhi HC. Study of left ventricular systolic dysfunction, left ventricular diastolic dysfunction and pulmonary hypertension in CKD 3b-5ND patients-A single centre cross-sectional study. Nefrología. 2022;22.

Kulkarni IJ, Mane MB. Assessment of Cardiac Function in Patients of Chronic Kidney Disease. Ann Rom Society Cell Biol. 2021 Apr 15:6091-6.

Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. The prognostic importance of left ventricular geometry in uremic cardiomyopathy. J Am Soc Nephrol. 1995;5:2024-31.

Chinali M, De Simone G, Matteucci MC, Picca S, Mastrostefano A, Anarat A et al. Reduced systolic myocardial function in children with chronic renal insufficiency. J Am Soc Nephrol. 2007;18:593 8.

Adiele DK, Okafor HU, Ojinnaka NC, Onwubere BJ, Odetunde OI, Uwaezuoke SN. Echocardiographic findings in children with chronic kidney disease as seen in the resource-limited setting. J Nephrol Ther. 2014;4:158 61

Shin DH, Lee YK, Oh J, Yoon JW, Rhee SY, Kim EJ et al. Vascular calcification and cardiac function according to residual renal function in patients on hemodialysis with urination. PloS one. 2017;12(9):e0185296.

Hensen LC, Goossens K, Delgado V, Abou R, Rotmans JI, Jukema JW et al. Prevalence of left ventricular systolic dysfunction in pre‐dialysis and dialysis patients with preserved left ventricular ejection fraction. Eur J Heart Failure. 2018;20(3):560-8.

Hayashi SY, Rohani M, Lindholm B. Left ventricular function in patients with chronic kidney disease evaluated by colour tissue Doppler velocity imaging. Nephrol Dial Transplant. 2006;21:125-32.

Ramegowda RB, Samdeshi AL, Khanvilkar Y. A study of Echocardiographic changes in patients with chronic kidney disease in a tertiary care centre in South Karnataka. 2018;7.

London GM, Pannier B, Guerin AP. Alterations of left ventricular hypertrophy in and survival of patients receiving hemodialysis: follow-up of an interventional study. J Am Soc Nephrol. 2001;12:2759-67.

Levin A, Singer J, Thompson CR, Ross H, Lewis M. Prevalent left ventricular hypertrophy in the pre-dialysis population: identifying opportunities for intervention. Am J Kidney Dis 1996;27:347-54.

Rong S, Qiu X, Jin X, Shang M, Huang Y, Tang Z, Yuan W. Risk factors for heart valve calcification in chronic kidney disease. Medicine. 2018 Feb;97(5).

Li K, Yang C, Lu A. Age-related changes in calcification of heart valves. Chin J Geriatr. 2013;32:934-6

Wheeler DC. Cardiovascular disease in patients with chronic renal failure. Lancet. 1996;348:1673-4.

Ravi V, Iskander F, Saini A, Brecklin C, Doukky R. Clinical predictors and outcomes of patients with pericardial effusion in chronic kidney disease. Clinical cardiology. 2018;41(5):660-5.

Qian Q, Hartman RP, King BF, Torres VE. Increased occurrence of pericardial effusion in patients with autosomal dominant polycystic kidney disease. Clin J Am Society Nephrol. 2007;2(6):1223-7

Mavrakanas TA, Khattak A, Wang W, Singh K, Charytan DM. Association of Chronic Kidney Disease with preserved ejection fraction heart failure is independent of baseline cardiac function. Kidney and Blood Pressure Research. 2019;44(5):1247-58.

Assa S, Hummel YM, Voors AA, Kuipers J, Westerhuis R, De Jong PE, Franssen CF. Hemodialysis-induced regional left ventricular systolic dysfunction: prevalence, patient and dialysis treatment-related factors, and prognostic significance. Clin J Am Society Nephrol. 2012;7(10):1615-23.

Downloads

Published

2022-12-27

Issue

Section

Original Research Articles