Why the study?
Fluid overload is common in diabetes and CKD and can lead to cardiac abnormalities, but its impact on cardiac alterations in non-dialysis-dependent CKD stage 5 without intrinsic heart disease needed evaluation.
Is fluid overload associated with left ventricular diastolic dysfunction and hypertrophy in patients with diabetes and non-dialysis-dependent CKD stage 5?
Is fluid overload associated with left ventricular diastolic dysfunction and hypertrophy in patients with diabetes and non-dialysis-dependent CKD stage 5?
Fluid overload is independently associated with left ventricular diastolic dysfunction and hypertrophy in patients with diabetes and non-dialysis-dependent CKD stage 5, suggesting volume status should be evaluated alongside cardiac structure.
Fluid overload was associated with LVDD and LVH in DMCKD5-ND; leaves open whether volume control alters cardiac remodeling.
BACKGROUND: Fluid overload is common in patients with diabetes and chronic kidney disease (DM and CKD; DMCKD) and can lead to structural and functional cardiac abnormalities including left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD). Fluid overload represents a crucial step in the pathophysiological pathways to chronic heart failure in patients with end-stage renal disease. We evaluated the impact of fluid overload on cardiac alterations in patients with diabetes and non-dialysis-dependent CKD stage 5 (DMCKD5-ND) without intrinsic heart disease. METHODS: Bioimpedance spectroscopy, echocardiography, and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) measurement were performed in 135 consecutive patients on the same day. Patients were divided into groups by tertiles of overhydration/extracellular water (OH/ECW) per bioimpedance spectroscopy. RESULTS: Fluid balance markers including OH/ECW and NT-proBNP were significantly higher in the LVDD+LVH group. OH/ECW and its exacerbation were positively associated with the ratio between early mitral inflow and annular early diastolic velocities (E/e' ratio) and left ventricular mass index (LVMI). The prevalence of LVH progressively increased across increasing tertiles of OH/ECW. In multiple regression analyses, OH/ECW as a continuous and categorical variable was independently associated with the E/e' ratio and LVMI after adjustment for multiple confounding factors. CONCLUSIONS: Fluid overload was independently associated with LVDD and LVH in patients with DMCKD5-ND. Our study suggests that structural and functional cardiac abnormalities and volume status should be evaluated simultaneously in patients with early-stage DMCKD rather than only DMCKD5-ND, in addition to intensive blood pressure and glycemic control, regardless of evident cardiovascular disease.
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Han et al. (2020) studied this question.
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