Preclinical Systolic Dysfunction in Patients with Stage 3 Chronic Kidney Disease

Introduction: Chronic kidney disease (CKD) is associated with increased cardiovascular risk and mortality. We evaluated whether stage 3 (s3)-CKD is associated with abnormalities of the cardiovascular system. Methods: Thirty-nine asymptomatic s3-CKD patients, free of prevalent cardiovascular disease, were compared with 44 control subjects with comparable prevalence of hypertension (66% vs 69% in s3-CKD). In addition to standard echocardiographic parameters, we computed non-invasive effective arterial elastance (EAE, in mmHg/mL/beat), systolic left ventricular elastance (LVe, in mmHg/mL) and myocardial mechanic efficiency (MME, in mL/sec), using previously reported formulas. Results: s3-CKD and controls were comparable for age, sex, lipid profile and prevalence of diabetes mellitus and smoking habit. Left ventricular (LV) mass, geometry and stroke work were similar in the two groups, with both ejection fraction and midwall shortening (mS) significantly reduced in the CKD group (both p < 0.001). Within the s3-CKD group, 36% had clear-cut depressed mS. EAE and peripheral resistance were higher in s3-CKD than in controls (both p < 0.005), and MME was reduced in CKD (p < 0.005), an impairment even clearer after controlling for LV mass, and increasing with increasing values of LV mass (p < 0.001). In addition, at a given level of peripheral resistance, LV geometry was less concentric in s3-CKD than in controls (p < 0.05). Conclusions: s3-CKD asymptomatic patients show a peculiar cardiovascular phenotype, characterized by impaired mechano-energetic efficiency and reduced midwall mechanics, in the presence of inadequately compensating LV concentric remodelling. Whether these characteristics might result in higher cardiovascular risk in s3-CKD should be investigated.