Cardiovascular Involvement in Patients with Chronic Kidney Disease.

Unlabelled: Cardiovascular disease (CVD) is the supreme cause of morbidity and mortality amid patients with chronic kidney disease (CKD). In spite of alteration for known CAD risk factors, including hypertension & diabetes, mortality risk dynamically intensifying with worsening condition of CKD. CKD is non-communicable disease typically caused by diabetes and hypertension. The extremity of CKD can be proficient by a reasonable serum creatinine-based estimated eGFR, which also indicates excretory kidney function, and elevated urinary albumin measured by the urinary albumin-to-creatinine ratio (ACR), which is a best predictor of kidney damage.

Material: To assess the systolic & diastolic dysfunction in patients with Chronic Kidney Disease (CKD). Fifty patients with CKD were subjected to two-dimensional and M mode echocardiography for determination of systolic and diastolic dysfunction. ECG were performed to detect MI, ischemia, LVH and other cardiovascular abnormality. All patients were evaluated clinically, biochemically and radio logically and were diagnosed as chronic kidney disease (CKD). The left ventricular ejection fraction (LVEF) and fractional shortening (FS) were taken as measures of left ventricular (LV) systolic function. Diastolic function was determined by measuring E/A ratio by spectral Doppler LV inflow velocity. Echocardiographic findings of hypertensive and normotensive patients were compared.

Observation: Out of 50 patients studied, there were 35 males (70%) and 15 females (30%). Hypertension (60%) was leading cause of CKD. Echocardiography showed that left ventricular hypertrophy (LVH) was present in 74%. Systolic dysfunction as measured by reduced fractional shortening (< 25%) and decreased LVEF (< 50%) was present in 8 % and 12 % respectively. Diastolic dysfunction as denoted by E/A ratio of less than 0.75 or more than 1.8 was present in 60 % of patients. Regional wall motion abnormality (RWMA) was present in 12 %. Pericardial effusion was noted in 14 % of patients. Valvular calcification was noted in 8 % of CKD patients. Mean left ventricular internal diameter in diastole was 41 ± 6 mm. Mean Interventricular septum diameters in systole was11.9 ± 1.21 mm. Mean left atrium diameter was 29 ± 4 mm. Normotensive group was compared to hypertensive group. Statistically significant difference was noted in LVH and E/A ratio in hypertensive group as compared to normotensive group.

Conclusion: We conclude that left ventricular diastolic dysfunction also occurs in patients who having early stage of CKD. But patients with hypertensive CKD had higher prevalence of diastolic and systolic dysfunction as compared to normotensive counterparts.