Kidney Week

Abstract: SA-PO991

Cardiac structure in Patients with Mild to Moderate CKD – an MRI Study

Session Information

• Hypertension and CVD: Mechanisms - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1403 Hypertension and CVD: Mechanisms

Authors

• Schneider, Markus P., University Hospital Erlangen, Erlangen, Germany

Markus P. Schneider,

• Scheppach, Johannes B., Johns Hopkins University, Baltimore, Maryland, United States

Johannes B. Scheppach,

• Klink, Thorsten, University Hospital Würzburg, Würzburg, Germany

Thorsten Klink,

• Wanner, Christoph, University Hospital Würzburg, Würzburg, Germany

Christoph Wanner,

• Schlieper, Georg, RWTH University of Aachen, Aachen, Germany

Georg Schlieper,

• Saritas, Turgay, RWTH University of Aachen, Aachen, Germany

Turgay Saritas,

• Floege, Jürgen, RWTH University of Aachen, Aachen, Germany

Jürgen Floege,

• Schmieder, Roland E., University Hospital Erlangen, Erlangen, Germany

Roland E. Schmieder,

• Eckardt, Kai-Uwe, University Medicine-Charite, Berlin, Germany

Kai-Uwe Eckardt,

Background

Abnormal cardiac structure, in particular left ventricular hypertrophy (LVH), is common in patients with advanced chronic kidney disease (CKD), and predisposes to heart failure and sudden cardiac death. The prevalence, patterns and determinants of abnormal cardiac structure in patients with mild to moderate CKD has not been studied with magnetic resonance imaging (MRI).

Methods

We examined cardiac structure by MRI in 290 patients with mild to moderate CKD (median eGFR 50 ml/min), and explored associations with clinical and hemodynamic parameters (Mobil-O-Graph®, IEM, Germany), hydration status (bioimpedance spectroscopy), endothelial function (flow-mediated vasodilation), inflammation (high sensitive C-reactive protein, interleukin-6, tumor necrosis factor(TNF)-α, soluble TNF-receptors I and II) and CKD-mineral bone disease (MBD) markers (calcium, phosphate, 1,25-OH Vitamin D, intact parathyroid hormone, α-klotho, intact fibroblast growth factor (FGF)-23, C-terminal FGF-23). Linear regression analyses were used to identify variables independently associated with cardiac structure.

Results

Normal geometry was found in 56%, dilation in 4%, concentric remodeling in 10%, and LVH in 29% of patients. Abnormal cardiac structure was more prevalent in women than in men with CKD (P=0.06). Greater left ventricular mass (LVM) was independently associated with the variables male gender, greater BMI and higher 24h-systolic blood pressure (24h-SBP). Concentric remodeling was independently associated with male gender, higher 24h-SBP and greater hemoglobin levels. Neither endothelial function, nor hydration status or any of the inflammatory or CKD-MBD parameters contributed to the models.

Conclusion

Using state-of-the art MRI, abnormal cardiac structure was found in almost half of all patients with mild to moderate CKD. Targeting the modifiable factors 24h-SBP, BMI (for LVM) and avoiding high hemoglobin concentrations (for concentric remodeling) may prevent the development of adverse cardiac structure in patients with mild to moderate CKD.

Funding

• Commercial Support – Fresenius Medical Care