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Abstract
The majority of patients with end stage renal disease die of cardiovascular causes. Comorbid conditions like diabetes and hypertension are shared by both chronic kidney disease (CKD) and cardiovascular disease. To help physicians to identify high risk CKD patients, there is a need of sensitive biomarker to detect subclinical cardiac abnormalities in the early stages of CKD to permit initiation of necessary therapeutic intervention.
CKD results in several alterations in cardiovascular structure and function. We hypothesized that left atrial (LA) volume and LA strain would be sensitive markers of myocardial involvement in early CKD even in the presence of co existent diabetes and hypertension. We also hypothesized that LA metrics would be more sensitive parameters than LV parameters. We further hypothesized that LA metrics may be more sensitive than the measurement of N terminal brain naturetic peptide (NT- ProBNP) to detect myocardial dysfunction in CKD patients.
To prove these congruent hypotheses, we recruited three groups of patients; the first group comprised of stage 3 CKD patients (30-59mL/min/1.73m2) with or without hypertension and or diabetes but without any previous cardiac events. Control groups were age and sex matched subjects with hypertension and or diabetes with normal renal function, without any previous cardiac history and the third group comprised of healthy adults. We additionally studied patients with diabetes and hypertension without CKD, to examine the independent effect of these conditions on LA parameters.
We found that LA metrics were significantly reduced in both the CKD group and the risk factor matched control group, compared with normal subjects. Importantly, LA metrics were significantly altered in CKD patients compared to risk factor matched subjects indicating these parameters are sensitive markers to detect myocardial involvement despite the presence of coexistent hypertension and diabetes. LA volume and strain also showed incremental value in diagnosing myocardial dysfunction in CKD in the presence of hypertension and diabetes. Finally we compared LA parameters with
NT- ProBNP; even though NT- ProBNP was significantly elevated in CKD patients compared to the control group, levels were below the upper normal reference range whereas LA metrics were significantly altered compared to control group. These findings indicate that LA metrics are a sensitive, non-invasive tool to detect myocardial involvement in early CKD.