Left Ventricular Dysfunction in Different Stages of Chronic Kidney Disease

Abstract

BACKGROUND: Chronic kidney disease (CKD) is becoming a significant global public health concern. According to the Global Burden of Disease study, it was responsible for approximately 1.4 million deaths worldwide in 2021, marking a 20% increase since 2010—one of the most substantial rises among leading causes of death. Premature cardiovascular disease remains the primary cause of illness and death in chronic kidney disease patients, often leading to fatal outcomes before they reach end-stage kidney disease. Therefore, early intervention is crucial to prevent cardiovascular complications in chronic kidney disease patients. A two-dimensional echocardiogram serves as a simple, non-invasive tool to evaluate left ventricular structure and function, aiding in the early identification of individuals at risk for cardiovascular complications.

METHODS: A Cross-sectional study was conducted among 88 patients diagnosed with chronic kidney disease in Adichunchanagiri Hospital and Research Centre. Relevant information was collected from each subject. In all the selected subjects detailed history was taken and physical examination was done through a pretested and structured pro forma. Every patient was subjected to relevant investigations. All of the above was done after taking an informed consent. The percentage of patients with ventricular dysfunction was estimated in each stage and grade of CKD and association between left ventricular dysfunction and stages of CKD was done.

RESULT: In this study, the largest proportion of participants (50%) were classified as G5A1, followed by 19.32% as G4A1, 15.91% as G5A2, and 1.14% as G5A3. Overall, 67.05% of the study population had Grade 5 CKD, while 23.86% had Grade 4 CKD. Left ventricular systolic dysfunction was observed in 30.68% of participants, while left ventricular diastolic dysfunction was noted in 64.78%. Among those with CKD stage 5, 28.81% had systolic dysfunction, compared to 38.09% in stage 4 and 28.57% in stage 3b. Diastolic dysfunction was present in 59.32% of stage 5 patients, 76.19% of stage 4 patients, and 71.42% of those in stage 3b.There was a significant association noted between renal parameters and left ventricular dysfunction . No association was noted between staging and left ventricular dysfunction.

CONCLUSION: Left ventricular dysfunction is common in patients with CKD. Since there is no association proved between the stages of CKD and left ventricular dysfunction statistically, a strong advocation for early screening is needed. Two-dimensional echocardiogram is a good non-invasive investigation for the same. Patients also need to be screened for risk factors augmenting the ventricular dysfunction.