Why the study?
Increased vascular stiffness, fluid overload, and left ventricular diastolic dysfunction are common in CKD, but the potential moderating effect of volume status on the relationship between arterial stiffness and left ventricular diastolic function was unclear.
Does fluid overload moderate the relationship between arterial stiffness and left ventricular diastolic function in non-dialysis patients with stage 5 CKD?
Does fluid overload moderate the relationship between arterial stiffness and left ventricular diastolic function in non-dialysis patients with stage 5 CKD?
Fluid overload aggravates left ventricular diastolic dysfunction in CKD patients with increased arterial stiffness, highlighting the need for simultaneous assessment of vascular stiffness, fluid balance, and LV function.
Fluid overload may moderate arterial stiffness effects on diastolic function in stage 5 CKD, especially women; hypothesis-generating pending prospective data.
Increased vascular stiffness, fluid overload, and left ventricular diastolic dysfunction (LVDD) are common in patients with chronic kidney disease (CKD). We investigated the potential moderating effect of volume status in the relationship between arterial stiffness and left ventricular (LV) diastolic function in non-dialysis patients with stage 5 CKD. The radial augmentation index at a heart rate of 75 beats/min (rAIx75), overhydration/extracellular water (OH/ECW), and E/e´ ratio were concurrently measured in 152 consecutive patients. Each of these parameters reflects the status of vascular stiffness, fluid balance, and LV diastolic function, respectively. Hierarchical regression analysis demonstrated a significant interaction effect of OH/ECW for all patients (P = 0.015), even after controlling for confounders. In separate analyses, this interaction effect was particularly significant in women (P = 0.010), whereas its significance in patients with diabetes was marginally significant (P = 0.062). Our study suggested that fluid overload could be one of the more aggravating factors of LVDD in patients with CKD who have increased arterial stiffness. Therefore, it is advisable to conduct simultaneous assessments of vascular stiffness, fluid balance, and LV function, particularly in the specific groups mentioned earlier. Our results may serve as evidence applicable to patients with chronic heart failure.
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Han et al. (2024) studied this question.
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