Takotsubo Cardiomyopathy and Chronic Kidney Disease: A Scoping Study.

Abstract

Sympathetic nervous system hyperactivity and elevated catecholamine levels are known features of chronic kidney disease (CKD). On the other hand, CKD itself is a high risk for Cardiovascular disease (CVD) and in fact most patients with CKD die before reaching dialysis. Furthermore, Many CKD risk factors such as obesity, hypertension, diabetes are also associated with sympathetic hyperactivity. Sympathetic hyperactivity and elevated catecholamine levels also play a key role in the pathogenesis of takotsubo cardiomyopathy (TKCM). Owing to the high sympathetic tone and elevated catecholamine levels in CKD/ESRD patients, an acute stress such as infection/sepsis or surgery makes these patients highly susceptible to TKCM. Multiple isolated case reports of TKCM in CKD/ESRD patients have been reported. We here present the first scoping study of such cases. The purpose of this review is to identify the characteristic features of ESRD/CKD who developed TKCM. Analysis of 30 cases of TKCM in CKD/ESRD primarily happens in women (87% of the cases) with a mean age of 64 ± 13 yrs (Median 63 yrs). Dyspnea (60%) was most presenting complaint, followed by chest pain (37%), fatigue (10%), lower limb edema (3%), seizures (3%) and confusion (3%). The majority of TKCM was noted after exposure to an acute physiological or psychological stressor. Physicians should have a high clinical suspicion for TKCM amongst other differential diagnosis in CKD/ESRD patients who present with chest pain or dyspnea in the setting of acute physiological or psychological stressor.