Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study

Abstract

Background Chronic kidney disease (CKD) is an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study investigated the relationship between CKD and left atrial (LA) volume and function in a sample of the general population without overt cardiac disease. Design and methods We examined 358 participants from the Cardiovascular Abnormalities and Brain Lesions study. The LA minimum volume index (LAVI), LA maximum volume index (LAVI), and LA emptying fraction (LAEF) were assessed by real-time three-dimensional echocardiography. Based on their estimated glomerular filtration rate (eGFR), the participants were divided into a CKD group (eGFR <60 ml/min/1.73 m) and a non-CKD group (eGFR ≥60 ml/min/1.73 m). Results Of the 358 participants, 69 (19%) were classified as having CKD and 289 (81%) as non-CKD. Participants with CKD were older, had a greater prevalence of hypertension and use of antihypertensive drugs, a larger left ventricular (LV) mass index, and a higher prevalence of diastolic dysfunction than those without CKD (all p < 0.05). There was no significant difference in LAVI between the CKD and non-CKD groups (23.4 ± 7.1 vs. 22.8 ± 5.8 ml/m, p = 0.47), whereas significant differences were observed for LAVI (13.6 ± 5.5 vs. 12.0 ± 4.6 ml/m, p = 0.01) and LAEF (42.7 ± 11.4 vs. 47.8 ± 11.5%, p = 0.001). Multivariate regression analysis revealed that the eGFR was significantly associated with LAEF independent of age, LV mass index, and diastolic dysfunction (all p < 0.05). Conclusions Participants with CKD in an unselected community-based cohort had significantly impaired LA reservoir function. Assessment of LA function may add important information in the prognostic assessment of patients with CKD even in the absence of overt cardiac disease.

Association of central blood pressure with left atrial structural and functional abnormalities in hypertensive patients: Implications for atrial fibrillation prevention

“…Both left atrium enlargement and left atrium dysfunction have been evidenced to contribute to and pose an increased risk for atrial fibrillation and associated complications, 21,22 even in the absence of overt heart disease, especially when other predisposing conditions, such as chronic renal impairment, coexist. 23…”

Association between E/e´ ratio and fluid overload in patients with predialysis chronic kidney disease

“…Among these biomarkers, diastolic dysfunction has been reported to be an independent predictor of mortality in multivariate analysis. Diastolic dysfunction involves abnormal LV relaxation, filling, and distensibility and is frequently found in patients with CKD [ 3 – 5 ]. Diastolic dysfunction may develop early in CKD [ 6 ] and is common in later stages.…”

Association between OH/ECW and echocardiographic parameters in CKD5 patients not undergoing dialysis

“…We also objectively assessed the volume status of the patients at the time of echocardiography with BIS. Diastolic dysfunction is common among CKD patients, and worsens with increases in volume, culminating in both structural changes (such as cardiac stiffness) and functional crises (such as heart failure) [ 28 , 29 ]. Biomarkers that detect volume overload at the early phase and allow timely intervention are necessary because fluid overload is a modifiable risk factor.…”