A Study on Prevalence of Left Ventricular Dysfunction and Its Correlation with Estimated Glomerular Filtration Rate (eGFR) in CKD patients

BACKGROUND AND OBJECTIVE: In Chronic Kidney Disease there is a higher incidence cardiovascular events. Most of the patients with CKD succumb to cardiovascular disease even before they reach the end stage of renal disease. Hence all efforts should be given in earlier stages of CKD to prevent the development of cardiovascular complications. LV diastolic dysfunction is found to antedate LVH and systolic dysfunction. It is not just associated with hemodynamic factors like anaemia and hypertension, but also with uraemia related non hemodynamic factors like secondary hyperparathyroidism, altered mineral metabolism, cardiotrophysin etc. ECHO provides a simple non-invasive method to assess the left ventricular structure and function, which helps us in identifying those prone for cardiovascular complications at an earlier stage of CKD. This study was done to find out the prevalence of LV dysfunction and its correlation with eGFR in CKD patients. METHODS: 50 hypertensive CKD patients and 50 normotensive CKD patients admitted to Government Rajaji Hospital between May 2013 to August 2014 were evaluated for the presence of LV dysfunction and LVH and the results were compared with that of 50 age and sex matched individuals. Patients with acute kidney injury, prior coronary artery disease, valvular heart disease, cardiomyopathy, diabetic individuals and CKD patients on renal replacement therapy or transplant patients were excluded from the study. The CKD patients were divided into various stages of CKD based on their eGFR (calculated according to MDRD formula) and they were evaluated by ECHO. Those with an ejection fraction 2 was grade III diastolic dysfunction. This was compared with the ECHO findings of the controls. The collected data was analysed using various statistical methods. RESULTS: 74% of CKD patients had LV diastolic dysfunction (p <0.0001). Diastolic dysfunction was found to occur in 84% of the hypertensive CKD and in 64% of the normotensive CKD (p=0.02). Comparing the CKD normotensives with the control group, 64% among the normotensive CKD had diastolic dysfunction whereas only16% of controls had diastolic dysfunction (p<0.05). There is a negative correlation between the eGFR and diastolic dysfunction. So as the eGFR falls, the diastolic dysfunction increases. INTERPRETATION AND CONCLUSION: Even in the absence of hypertension, LV diastolic dysfunction can occur in CKD. This emphasizes the need for correction of not just hemodynamic factors but also the uraemia related factors.