What question did this study set out to answer?

This research aims to assess the effectiveness of myocardial strain versus volumetric measurements in evaluating the reversal of uraemic cardiomyopathy post-kidney transplantation.

March 26, 2026Open Access

Reversal of uraemic cardiomyopathy following kidney transplantation: systematic review and meta-analysis of myocardial strain compared to left ventricular volumetry as a potential early marker

Key Result

Kidney transplantation improved both myocardial strain (GLS SMD -1.57) and LV volumetry (LVMi SMD -17.93), showing strain is not a more sensitive marker of uraemic cardiomyopathy reversal.

Key Points

This research aims to assess the effectiveness of myocardial strain versus volumetric measurements in evaluating the reversal of uraemic cardiomyopathy post-kidney transplantation.
Conducted a systematic search on PubMed for relevant articles until November 2025.
Included studies with paired myocardial strain pre- and post-kidney transplantation in adult ESKD patients using echocardiography or cardiac magnetic resonance.
Performed meta-analysis on changes in myocardial strain and left ventricular volumetric measurements.
Ten echocardiographic and three CMR studies were included, with follow-up from 1 to 36 months.
Myocardial strain parameters improved significantly: LV GLS SMD -1.57; LV GCS SMD -1.63; LV GRS SMD 3.34.
Conventional LV volumetric measurements also showed improvement across all measured parameters.

Structured PICO

Does kidney transplantation improve myocardial strain and left ventricular volumetry in adult ESKD patients?

Population

Adult end-stage kidney disease (ESKD) patients

Intervention

Kidney transplantation (KTx)

Comparator

Pre-transplantation baseline

Outcome

Post-KTx changes in myocardial strain (GLS, GCS, GRS) and left ventricular (LV) volumetry (LVMi, LVEF, LVEDVi, and LVESVi)surrogate

Kidney transplantation reverses uraemic cardiomyopathy, with both myocardial strain and LV volumetry showing similar patterns of improvement, meaning strain could not be confirmed as a more sensitive marker.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Introduction Adverse cardiovascular changes associated with end-stage kidney disease (ESKD), referred to as uraemic cardiomyopathy, can potentially be reversed by kidney transplantation (KTx). Myocardial strain is hypothesized to be a more sensitive marker for reversal of uraemic cardiomyopathy following KTx than conventional left ventricle (LV) volumetric measurements. This meta-analysis study compared post-KTx changes in myocardial strain (GLS, GCS, GRS) and left ventricular (LV) volumetry (LVMi, LVEF, LVEDVi, and LVESVi) measured by cardiac magnetic resonance (CMR) and echocardiography. Methods A systematic search was performed on PubMed for articles published through November 2025, and studies meeting the inclusion criteria—assessing paired myocardial strain pre- and post-KTx in adult ESKD patients using echocardiography or CMR—were included in the meta-analysis. Results Ten echocardiographic and three CMR studies were included, with follow-up durations ranging from 1 to 36 months. Strain measurements improved across all parameters, LV GLS Standardized Mean Difference (SMD) -1.57 (95%CI -2.66, -0.48); p=0.0.005, LV GCS SMD -1.63 (95%CI -2.33, -0.93); p<0.00001 and LV GRS SMD 3.34 (95%CI 1.08, 5.59); p=0.004. Conventional LV volumetric measurements also improved, LVMi SMD -17.93 (95%CI -26.19, -9.68); p<0.0001, LVEF SMD 5.45 (95%CI 0.17, 10.72); p=0.04, LVEDVi SMD -12.72 (95%CI -17.59, -7.84); p<0.00001 and LVESVi [SMD -8.79 (95%CI -11.72, -5.86); p<0.0001. Conclusion These findings indicate a reversal of uraemic cardiomyopathy following KTx. However, since both strain and volumetric measurements showed similar patterns of improvement across CMR and echocardiography, myocardial strain could not be confirmed as a more sensitive marker of uraemic cardiomyopathy reversal than LV volumetry.