Effect of type 2 diabetes on the left ventricular diastolic dysfunction in patients with chronic kidney disease, 3 and 4 stages

Patients with chronic kidney disease (CKD) and coexisting diabetes mellitus (DM) are likely to have cardiological complications. We assessed whether patients with moderate kidney dysfunction, with coexisting type 2 DM and preserved left ventricular (LV) systolic function, demonstrate a more advanced LV diastolic dysfunction. The study group consisted of 58 ambulatory patients with CKD, stages 3 and 4. The patients were assigned to groups based on the presence of type 2 DM. The first group (DM+) consisted of 21 patients with type 2 DM while second one (DM−) consisted of 37 patients without type 2 DM. Standard echocardiography was performed in all patients with tissue Doppler echocardiography for evaluation of the systolic velocity and both diastolic velocities of LV. The following laboratory parameters were measured: serum creatinine concentration, estimated glomerular filtration rate, and the levels of urea, phosphorus, calcium, parathormone, platelets count, hemoglobin level and N-terminal pro-B-type natriuretic peptide levels. LV diastolic dysfunction was defined as EmLV less than 8 cm/s. Patients in DM+ group, as compared to patients in DM− group, were characterized by higher values of left and right ventricular end-diastolic dimension, left atrial diastolic dimension, interventricular septal diastolic diameter, LV posterior wall dimension at diastole and of LV mass index, smaller LV ejection fraction and LV fractional shortening. In tissue Doppler echocardiography patients of DM+ group, as compared to patients of DM− group, did not differ in value of EmLV (7.4 ± 2.4 cm/s vs. 7.6 ± 2.1 cm/s, P = .723), respectively, and were characterized by similar estimated LV diastolic filling pressure as indicated by E/EmLV (10.1 ± 3.7 vs. 8.8 ± 2.6, P = .119). CKD patients in the moderate stage, with coexisting type 2 DM were not characterized by higher risk of developing LV diastolic dysfunction.