Left ventricular diastolic dysfunction in the early stage of chronic kidney disease

Otsuka, Takenori; Suzuki, Michitaka; Yoshikawa, Hisao; Sugi, Kaoru

doi:10.1016/j.jjcc.2009.05.002

Cited by 60 publications

(64 citation statements)

References 25 publications

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“…9 Diastolic dysfunction has also been studied in small cohorts of CKD patients. 12,13 However, no study has characterized the associations of different stages of estimated GFR (eGFR) with the range of changes in cardiac structure and function in a large cohort of patients with established CKD. This study is an important first step in testing the hypothesis that cardiac structural changes are a key factor in the pathogenesis leading from reduced kidney function to accelerating HF risk.…”

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confidence: 99%

Associations between Kidney Function and Subclinical Cardiac Abnormalities in CKD

Park

Hsu

et al. 2012

Journal of the American Society of Nephrology

275

207

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Heart failure is a common consequence of CKD, and it portends high risk for mortality. However, among patients without known heart failure, the associations of different stages of estimated GFR (eGFR) with changes in cardiac structure and function are not well described. Here, we performed a cross-sectional analysis to study these associations among 3487 participants of the Chronic Renal Insufficiency Cohort Study. We estimated GFR using cystatin C. The prevalence of left ventricular hypertrophy (LVH) assessed by echocardiography was 32%, 48%, 57%, and 75% for eGFR categories $60, 45-59, 30-44, and ,30 ml/ min per 1.73 m 2 , respectively. In fully adjusted multivariable analyses, subjects with eGFR levels of ,30 ml/ min per 1.73 m 2 had twofold higher odds of LVH (OR=2.20, 95% CI=1.40-3.40; P,0.001) relative to subjects with eGFR$60 ml/min per 1.73 m 2 . This reduction in kidney function also significantly associated with abnormal LV geometry but not diastolic or systolic dysfunction. An eGFR of 30-44 ml/min per 1.73 m 2 also significantly associated with LVH and abnormal LV geometry compared with eGFR$60 ml/min per 1.73 m 2 . In summary, in this large CKD cohort, reduced kidney function associated with abnormal cardiac structure. We did not detect significant associations between kidney function and systolic or diastolic function after adjusting for potential confounding variables.

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confidence: 99%

Associations between Kidney Function and Subclinical Cardiac Abnormalities in CKD

Park

Hsu

et al. 2012

Journal of the American Society of Nephrology

275

207

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“…It suggested that E/E9 was superior to IVRT in detecting the association between LV diastolic function and renal function. Although eGFR has been widely used in the studies investigating the relationship between LV function and renal function, the association between small reductions in eGFR and abnormalities of cardiac structure and function is unclear [28], [29]. In an analysis of 40 non-CKD patients and 202 CKD patients, LV diastolic dysfunction was observed even in patients with early stages of CKD [28].…”

Section: Discussionmentioning

confidence: 99%

“…Although eGFR has been widely used in the studies investigating the relationship between LV function and renal function, the association between small reductions in eGFR and abnormalities of cardiac structure and function is unclear [28], [29]. In an analysis of 40 non-CKD patients and 202 CKD patients, LV diastolic dysfunction was observed even in patients with early stages of CKD [28]. In contrast, an independent relationship was not observed between eGFR and parameters of cardiac structure or function in an analysis of 540 hypertensive patients [29].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with elevated NT-proBNP, LV diastolic dysfunction was significantly associated with poorer renal function, but in patients with normal NT-proBNP, there was no relationship between LV diastolic function and renal function. Despite the expanse of information known about cardiac structure and function in patients with ESRD [7], [8], only a few studies have focused on the relationship between mild reductions in renal function and cardiac function in early hypertension [22], [28], [29]. The mechanisms responsible for the relationship between LV diastolic function and renal function in early hypertension are not well established.…”

Section: Discussionmentioning

confidence: 99%

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761 ASSOCIATION OF E/Ea AND NT-proBNP WITH RENAL FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Yang

Wang

Zhu

et al. 2012

Journal of Hypertension

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Objectives: To evaluate the association of left ventricular (LV) diastolic function and N-terminal pro-brain natriuretic peptide (NT-proBNP) with renal function in essential hypertension.Methods: LV diastolic function was estimated by the ratio of early diastolic velocities (E) from transmitral inflow to early diastolic velocities (E9) of tissue Doppler at mitral annulus (septal corner); NT-proBNP was measured in 207 hypertensive patients (mean age 56614 years). The subjects were classified into 3 groups: E/E9#10 group (n = 48), 10,E/E9#15 group (n = 109) and E/E9.15 group (n = 50). The renal function was estimated by glomerular filtration rate (GFR) with 99m Tc-DTPA. GFR from 30 to 59 ml/min/1.73 m 2 was defined as Stage 3 chronic kidney disease (CKD). GFR was also estimated using the modified MDRD equation. Albuminuria was defined by urinary albumin/creatinine ratio (UACR).Results: GFR was lower and UACR was higher in E/E9 .15 group than in 10, E/E9 #15 group or E/E9 #10 group (p,0.0001), GFR was significantly negative and UACR was positive correlated with E/E9 and NT-proBNP (p,0.0001). In multivariate stepwise linear analysis, GFR had significant correlation with age (p = 0.001), gender (p = 0.003), E/E9 (p = 0.03), lgNT-proBNP (p = 0.001) and lgUACR (p = 0.01), while eGFR had no significant correlation with E/E9 or lgNT-proBNP. Multivariate logistic regression analysis, adjusted for potential confounding factors, showed that participants in E/E9.15 group were more likely to have Stage 3 CKD compared with those in E/E9#10 group with an adjusted odds ratio of 8.31 (p = 0.0036).Conclusions: LV diastolic function, assessed with E/E9 and NT-proBNP is associated with renal function in essential hypertension.

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“…[9] Diastolic dysfunction has also been studied in small cohorts of CKD patients. [12,13] Renal dysfunction is closely related to prognosis of cardiovascular disease (CVD) and conversely CVD patients often develop acute renal failure: this association is referred to as the cardiorenal connection. Chronic renal dysfunction has a negative effect on cardiac function and chronic kidney disease (CKD) is an important predictor of adverse outcome and increased morbidity in patients with chronic heart failure (CHF).…”

Section: Introductionmentioning

confidence: 99%

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

Sidmal¹,

Hp²,

Kc³

2015

Int Jour of Biomed Res

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Background: The chronic kidney disease (CKD) is a major risk factor for coronary artery disease (CAD) and left ventricle systolic dysfunction. Left ventricular (LV) diastolic dysfunction in CKD patients frequently leads to the development of congestive heart failure. The interaction between diastolic dysfunction (DD) and renal function in subjects with preserved systolic function is not well defined. Objective: Our aim was to investigate whether renal insufficiency (RI) is associated with DD among patients with left ventricular ejection fraction (LVEF) > 50%, and to investigate whether there is a correlation between CKD and DD severity. Methods: Eighty four CKD patients, aged 35-79 were examined by standard echocardiography. Subjects were divided into 4 groups depending on their estimated glomerular filtration rate (eGFR: ml/min/BSA) as follows: group 1 (60-89 ml/min/BSA), group 2 (30-59 ml/min/BSA), group 3 (15-29 ml/min/BSA) and group 4 (less than 15 ml/min/BSA), between 1/2/2014 and 30/4/2015. Glomerular filtration rate (GFR) was estimated using the MDRD formula. Patients with impaired relaxation (grade I) were compared to those with pseudonormal (grade II) or restrictive (grade III-IV) DD. Results: Among 84 patients, 23 had GFR 60-89 ml/min/BSA; 16 had GFR 30-59 ml/min/BSA; and 19 had GFR 15-30 ml/min/BSA and 26 had GFR <15 ml/min/BSA. There was a significant correlation between worsening GFR and degree of diastolic dysfunction (DD) assessed by echo. Overall, 40.4% of the participants were female, 22 (26.1 %) had grade I, & 10 (11.9 %) had grade II, 16 (19%) had grade III and 36 (42.8%) had grade IV diastolic dysfunction. Almost all patients had some degree of diastolic dysfunction. With worsening of renal function, there was worsening of diastolic dysfunction seen. In patients with end stage renal disease many had grade IV diastolic dysfunction as compared to patients with early CKD. Grade I and II DD was commonly seen in group 1 and 2. But grade III and IV DD was commonly seen in group 3 and 4. Conclusion: Worsening renal function was associated with greater degree of diastolic dysfunction and adverse clinical outcomes. Our Study indicated a clear and independent association between RI and DD. The severity of RI also tends to correlate with the severity of DD. And that LV diastolic dysfunction was observed even in patients with early stages of chronic kidney dysfunction.

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Left ventricular diastolic dysfunction in the early stage of chronic kidney disease

Abstract: These data suggest that LV diastolic dysfunction was observed even in patients with early stages of chronic kidney dysfunction. Doppler indices combined with conventional and tissue Doppler methods could detect the subtle changes of diastolic function due to kidney dysfunction.

Cited by 60 publications

References 25 publications

Associations between Kidney Function and Subclinical Cardiac Abnormalities in CKD

Associations between Kidney Function and Subclinical Cardiac Abnormalities in CKD

761 ASSOCIATION OF E/Ea AND NT-proBNP WITH RENAL FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

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