Left Ventricular Diastolic Dysfunction Common in Non-Dialysis Chronic Kidney Disease

A study found that the prevalence of left ventricular diastolic dysfunction (LVDD) in patients with chronic kidney disease (CKD) that do not require dialysis is 43.65%. These findings were published in Nefrologia.

This cross-sectional observational study was conducted at the Banaras Hindu University in India between 2020 and 2021. Patients (N=378) with stage 3b-5ND CKD according to the Kidney Disease Improving Global Outcomes 2012 guidelines were evaluated for cardiovascular health using transthoracic 2-dimensional (2D) and doppler echocardiography.

The patients were aged mean 51.56±13.39 years, 65.6% were men, and the most common CKD etiology was diabetic kidney disease (37.6%).

The prevalence of LVDD was 43.65%. In patients with LVDD 56.96% had grade 1, 27.88% had grade 2, and 15.16% had grade 3. Significant predictors of LVDD included hypertension (odds ratio [OR], 4.692; 95% CI, 2.464-8.933; P <.001) and duration of CKD (OR, 1.807; 95% CI, 1.072-3.047; P =.03).

The prevalence of left ventricular systolic dysfunction (LVSD) was 15.6%. In patients with LVSD left ventricular ejection fraction was 41% to 50% among 28.8%, 31% to 40% among 67.8%, and 30% or more among 3.4%. LVSD was associated with duration of CKD (OR, 2.731; 95% CI, 1.093-6.821; P =.03), urine protein concentration (OR, 1.725; 95% CI, 1.195-2.490; P =.004), estimated glomerular filtration rate (eGFR; OR, 0.828; 95% CI, 0.711-0.965; P =.02), and serum albumin concentration (OR, 0.124; 95% CI, 0.045-0.347; P <.001).

Severity of LVDD correlated with serum creatinine concentration (r, 0.388; P <.001), duration of CKD (r, 0.450; P <.001), serum intact parathyroid hormone levels (iPTH; r, 0.198; P =.01), serum uric acid concentration (r, 0.188; P =.02), eGFR (r, -0.353; P <.001), and serum vitamin D concentration (r, -0.194; P =.001). LVSD correlated with serum albumin concentration (r, -0.268; P =.04).

The prevalence of pulmonary hypertension (PH) was 12.2%. Among patients with PH 6.6% had comorbid LVDD. The significant predictors for PH were duration of CKD (OR, 3.838; 95% CI, 1.276-11.547; P =.02), hemoglobin (OR, 1.877; 95% CI, 1.169-3.012; P =.009), serum iPTH concentration (OR, 0.995; 95% CI, 0.991-1; P =.04), and serum vitamin D concentration (OR, 0.880; 95% CI, 0.827-0.936; P <.001).

This study does not evaluate type of PH and is not able to assess causal relationships due to its cross-sectional design.

“In our study the prevalence of PH is 12.2%, LV systolic dysfunction is 15.6% and LVDD is 43.65%,” the study authors wrote. “Prognostic implications and utility of these predictors requires prospective or randomized control studies for better validation.”

Reference

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. Nefrologia. Published online July 14, 2022. doi:10.1016/j.nefro.2022.06.001