Diffuse Intermyocardiocytic Fibrosis in Uraemic Patients

Mall, Gerhard; Hüther, W; Schneider, J.; Lundin, Peter; Ritz, Eberhard

doi:10.1093/ndt/5.1.39

Cited by 252 publications

(175 citation statements)

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“…In contrast to dialysis, renal transplantation can help prevent the progression of pathological cardiovascular processes. Renal transplantation can potentially reverse myocardial damage that is thought to result from prolonged exposure to uremic toxins and improve LV systolic function 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Bhatti

Galougahi

Paz

et al. 2016

JAHA

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Section: Introductionmentioning

confidence: 99%

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Bhatti

Galougahi

Paz

et al. 2016

JAHA

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“…[53,54] Morphological changes in the heart include-LVH, advanced coronary atherosclerosis microvascular disease and diffuse interstitial myocardial fibrosis. [55,56] These abnormalities are common in CKD patients and have been shown in to be predictive of mortality. [57,58] Assessment of diastolic function by echocardiography has shown a high incidence of abnormalities in dialysis and nondialysis CKD patients.…”

Section: Discussionmentioning

confidence: 99%

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

Sidmal¹,

Hp²,

Kc³

2015

Int Jour of Biomed Res

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Background: The chronic kidney disease (CKD) is a major risk factor for coronary artery disease (CAD) and left ventricle systolic dysfunction. Left ventricular (LV) diastolic dysfunction in CKD patients frequently leads to the development of congestive heart failure. The interaction between diastolic dysfunction (DD) and renal function in subjects with preserved systolic function is not well defined. Objective: Our aim was to investigate whether renal insufficiency (RI) is associated with DD among patients with left ventricular ejection fraction (LVEF) > 50%, and to investigate whether there is a correlation between CKD and DD severity. Methods: Eighty four CKD patients, aged 35-79 were examined by standard echocardiography. Subjects were divided into 4 groups depending on their estimated glomerular filtration rate (eGFR: ml/min/BSA) as follows: group 1 (60-89 ml/min/BSA), group 2 (30-59 ml/min/BSA), group 3 (15-29 ml/min/BSA) and group 4 (less than 15 ml/min/BSA), between 1/2/2014 and 30/4/2015. Glomerular filtration rate (GFR) was estimated using the MDRD formula. Patients with impaired relaxation (grade I) were compared to those with pseudonormal (grade II) or restrictive (grade III-IV) DD. Results: Among 84 patients, 23 had GFR 60-89 ml/min/BSA; 16 had GFR 30-59 ml/min/BSA; and 19 had GFR 15-30 ml/min/BSA and 26 had GFR <15 ml/min/BSA. There was a significant correlation between worsening GFR and degree of diastolic dysfunction (DD) assessed by echo. Overall, 40.4% of the participants were female, 22 (26.1 %) had grade I, & 10 (11.9 %) had grade II, 16 (19%) had grade III and 36 (42.8%) had grade IV diastolic dysfunction. Almost all patients had some degree of diastolic dysfunction. With worsening of renal function, there was worsening of diastolic dysfunction seen. In patients with end stage renal disease many had grade IV diastolic dysfunction as compared to patients with early CKD. Grade I and II DD was commonly seen in group 1 and 2. But grade III and IV DD was commonly seen in group 3 and 4. Conclusion: Worsening renal function was associated with greater degree of diastolic dysfunction and adverse clinical outcomes. Our Study indicated a clear and independent association between RI and DD. The severity of RI also tends to correlate with the severity of DD. And that LV diastolic dysfunction was observed even in patients with early stages of chronic kidney dysfunction.

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“…31,32 Experimental studies suggest that increased advanced glycation end-product formation associated with hyperglycaemia may be linked with increased myocardial stiffening and dysfunction. 33,34 Increased myocardial fibrosis presumably contributes to myocardial ischaemia due to the reduction in capillary density and coronary reserve.…”

Section: Discussionmentioning

confidence: 99%

Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

et al. 2010

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Left ventricular hypertrophy (LVH) and diastolic dysfunction are very common in patients with chronic kidney disease (CKD). Aim of this study was to evaluate the impact of type 2 diabetes on LV geometry and diastolic function in hypertensive patients with CKD. We enrolled 288 Caucasian subjects with hypertension and CKD; of them, 112 had diabetes. Patients with cardiovascular (CV) diseases, glomerular filtration rate (GFR) 460 ml min À1 per 1.73 m 2 , dialysis treatment and other major non-CV diseases were excluded. All patients underwent routine biochemical analyses and echocardiographic examination with tissue Doppler imaging (TDI). Patients with diabetes had significantly higher LV wall thicknesses (P ¼ 0.0001), relative wall thickness (RWT) (P ¼ 0.0001) and left atrium volume index (P ¼ 0.03), when compared with patients without diabetes. Further, diabetic patients had very high prevalence of concentric LVH. Em, evaluated by TDI, was significantly lower in patients with diabetes (P ¼ 0.005). However, the difference lost statistical significance after correction by analysis of covariance for RWT. Multiple stepwise linear regression analysis showed that the variables independently associated with Em were: age (b 0.364; P ¼ 0.0001), GFR (beta 0.101; P ¼ 0.019), and the presence of diabetes (b 0.166; P ¼ 0.002). Our study showed that in hypertensive patients with CKD the presence of diabetes is associated with increased LV-wall thicknesses and concentric geometry; further, diabetes together with renal function (GFR) is associated with worse diastolic function, independently of potential confounders, such as age, gender, body mass index and blood pressure.

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Diffuse Intermyocardiocytic Fibrosis in Uraemic Patients

Cited by 252 publications

References 0 publications

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Pattern and severity of left ventricular diastolic dysfunction in early and end stage renal disease patients with or without dialysis in rural population in South India

Impact of type 2 diabetes on left ventricular geometry and diastolic function in hypertensive patients with chronic kidney disease

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