Kidney Week

Abstract: SA-PO922

The Association of Diastolic Dysfunction with CKD in Patients with Heart Failure

Session Information

• CKD: Clinical, Outcomes, Trials - III
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Langlo, Knut Asbjørn Rise, St. Olavs Hospital HF, Trondheim, Norway

Knut Asbjørn Rise Langlo,

• Lundgren, Kari Margrethe, NTNU, Trondheim, Norway

Kari Margrethe Lundgren,

• Cittanti, Elisa, NTNU, Trondheim, Norway

Elisa Cittanti,

• Hallan, Stein I., NTNU, Trondheim, Norway

Stein I. Hallan,

• Dalen, Havard, NTNU, Trondheim, Norway

Havard Dalen,

Background

Chronic Kidney Disease (CKD) is tightly connected to cardiac disease, including Chronic Heart Failure (CHF) through different Cardiorenal Syndromes (CRS). CHF caused by hypertension and CKD often presents with left ventricular hypertrophy, stiffening and increasing filling pressures depicted as Chronic Renocardial Syndrome, whereas CHF caused by primary myocardial disease display dilation of left ventricle with venous congestion leading to reduced renal perfusion in the Chronic Cardiorenal Syndrome. This heterogeneity in CRS complicates the study of its pathophysiology, and studies comparing echocardiographic features of diastolic function in CHF between CKD and non-CKD patients are scarce.

Methods

Patients from two regional heart failure clinics were included if they had stable CHF and were medically optimized. Echocardiographic recordings, analyses and estimation of filling pressure and grade of diastolic dysfunction were based on latest recommendations. Estimated glomerular filtration rate (eGFR) was calculated based on creatinine, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.

Results

Mean age of the 67 participants was 68 (65.6-71.1) years (82 % male). eGFR〈60 ml/min/1,73m² was present in 46 %. Three patients were in dialysis and 1 had a renal transplant. NYHA class II and III was present in 77 % and 23%, respectively. Patients with elevated filling pressure had lower eGFR than patients with normal filling pressure (-14.8 ml/min/1.73m², p = 0.03). Indexed left atrial end-systolic volume was significantly larger in HF patients with eGFR〈60 ml/min/1.73m² compared to those with better renal function (11 ml/m², p = 0.02). Patients with grade I diastolic dysfunction had a higher eGFR compared to grade II (18 ml/min/1.73m², p = 0.01). The differences between grade I and III, and II and III diastolic dysfunction did not reach statistical significance.

Conclusion

Reduced renal function was associated with increased filling pressures and larger left atrial volumes in a general heart failure population. This shows a common trait in CKD-patients with CHF despite the otherwise heterogeneity in clinical presentation.

Funding

• Government Support - Non-U.S.