Prevalence and renal prognosis of left ventricular diastolic dysfunction in non-dialysis chronic kidney disease patients with preserved systolic function

Abstract

Background: Left ventricular (LV) diastolic dysfunction is common in non-dialysis chronic kidney disease (ND-CKD) patients; however, the prevalence estimated according to the new diagnostic criteria as well as the prognostic role of diastolic dysfunction on CKD progression remain unknown. Method:We longitudinally evaluated consecutive ND-CKD patients and preserved systolic function (LV ejection fraction > 50%). According to the recently updated guidelines, LV diastolic dysfunction was assessed by four echocardiographic variables (annular e 0 velocity, average mitral valve E-wave/e 0 ratio, left atrial volume index and tricuspid regurgitation). Patients were classified as diastolic dysfunction, indeterminate and normal. Time-dependent estimated glomerular filtration rate (eGFR) change was assessed by mixed-effects regression model. Cumulative incidence of composite renal outcome (eGFR decline > 50% or chronic dialysis) was also estimated.Results: Among 140 patients (age 66.2 AE 14.5 years; 61% males; eGFR 39.8 AE 21.8 ml/min per 1.73m 2 ; 43.6% diabetics), diastolic dysfunction occurred in 22.9%, indeterminate in 45.7% and normal in 31.4%. Prevalence of diastolic dysfunction was much lower than that estimated with older criteria (62.7%). Logistic regression (odds ratio, 95% confidence interval [CI]) showed that diastolic dysfunction was associated with lower eGFR (0.97, 0.94-0.99), older age (1.04, 1.01-1.06) and nighttime systolic blood pressure (1.04, 1.00-1.07). Across 1702 eGFR measurements collected during a median follow-up of 4.6 years, eGFR decline (ml/min per 1.73m 2 ; per year) was faster in patients with diastolic dysfunction (À2.12, 95% CI from À2.68 to À1.56) and in the indeterminate (11.2/100 pts per year) as compared to normal (À1.14, 95% CI from À1.64 to À0.63). Incidence of composite renal outcome was significantly higher in diastolic dysfunction (13.8/100 pts/year) than in normal group (3.5/100 pts per year)'. Conclusion:In ND-CKD population, LV diastolic dysfunction is less frequent than previously described and acts as independent predictor of CKD progression.

Diffusion tensor imaging of the brain white matter microstructure in patients with chronic kidney disease and its correlation with cognition

“…Patients with CKD are at a higher risk of cognitive impairment, and older patients on dialysis have the highest absolute risk ( 4 ). Neuroimaging studies have shown that patients with CKD tend to have structural and functional changes, such as white matter hyperintensities, asymptomatic stroke, and brain atrophy ( 5 , 6 ). The white matter of the brain acts as a relay station for the central nervous system and is responsible for the exchange of information and communication between different gray matter areas ( 7 , 8 ).…”

Diastolic function in chronic kidney disease

“…Assessment of diastolic dysfunction has been recently suggested to be a useful tool for predicting the development of adverse renal outcomes, defined as a >50% decrease in estimated GFR from baseline, doubling of serum creatinine, dialysis initiation and/or kidney transplantation [ 97 ], although no adjustment for LV geometry and geometry-independent systolic function was considered (only ejection fraction was used as a measure of systolic function). However, this has also been demonstrated in patients with preserved systolic function (defined as an ejection fraction >50%), further demonstrating that diastolic heart dysfunction is a risk factor for CKD progression, also after adjusting for the presence of body surface area–based LV hypertrophy [ 98 ], but not for other factors that might influence disease progression for both the heart and kidney (Fig. 4 ).…”

The Association between Echocardiographic Parameters of Heart Failure with Preserved Ejection Fraction and Fluid Status Biomarkers in Hemodialysis Patients

“…The pathogenesis of LV diastolic dysfunction in CKD patients includes abnormal ventricular filling in diastole and a higher left ventricular filling pressure because of LVH, in addition to myocardial interstitial fibrosis [ 19 ]. As a consequence, this condition is commonly found in pre-dialysis CKD subjects, even with preserved systolic function [ 20 ], as well as in hemodialysis patients [ 21 ]. Importantly, the prevalence of diagnosed diastolic dysfunction differed significantly as it was dependent on the older (2009) or newer (2016) ASE/EACVI criteria used [ 20 , 22 ].…”

“…As a consequence, this condition is commonly found in pre-dialysis CKD subjects, even with preserved systolic function [ 20 ], as well as in hemodialysis patients [ 21 ]. Importantly, the prevalence of diagnosed diastolic dysfunction differed significantly as it was dependent on the older (2009) or newer (2016) ASE/EACVI criteria used [ 20 , 22 ]. However, as volume overload and dyspnea symptoms, used in the cornerstone NYHA classification, are more commonly seen in CKD population, new, CKD-tailored criteria for heart failure diagnosis were proposed by the Acute Dialysis Quality Initiative (ADQI) a decade ago [ 23 ].…”