Objectives To examine arterial and left ventricular function and their interaction in patients with early stage chronic kidney disease (CKD).
Design & Setting Cross-sectional observational study in a university teaching hospital.
Patients 117 patients with stage 2 (60-89 ml/min/1.73m2) or stage 3 (30-59 ml/min/1.73m2) non-diabetic CKD, without overt cardiovascular disease were compared with 40 controls.
Interventions Aortic distensibility and LV mass were assessed using cardiac magnetic resonance imaging (CMR). Systolic and diastolic ventricular function and arterial-ventricular elastance (stiffness) were assessed by transthoracic echocardiography.
Main outcome measures Arterial stiffness as measured by aortic distensibility and arterial elastance. Left ventricular mass, left ventricular systolic and diastolic function including end diastolic and end systolic elastances and their relationship with arterial elastance.
Results Compared to controls, patients with CKD had reduced aortic distensibility (p<0.01), increased arterial elastance and increased ventricular end systolic and diastolic elastance (p<0.01). Aortic distensibility was positively correlated with estimated GFR (p<0.01) and indices of elastance were inversely correlated (p<0.05). Systolic function was not impaired in patients with early CKD compared to controls but diastolic filling velocities (Em) were reduced while mean left atrial pressure (E/Em) and end-diastolic elastance (Ed) were increased (p<0.01).
Conclusions Early stage CKD is characterized by reduced aortic distensibility and increases in arterial, ventricular systolic and diastolic stiffness; arterial-ventricular coupling is preserved. This pattern of patho-physiological abnormalities resembles that seen in heart failure with preserved ejection fraction and may account for the high levels of cardiovascular morbidity and mortality in patients at all stages of CKD.
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