Abstract
BackgroundEchocardiography is the most valuable tool for assessing cardiac abnormalities of chronic kidney disease (CKD) patients even though it has its limitations, including high equipment cost and the need for specialized personnel. Assessment of volume status is important not only for volume management, but also for prevention of cardiovascular disease of the CKD patients. Recently, bioimpedance is gaining acceptance as a way to quantitatively assess patient hydration status at bedside.Methods127 patients who were admitted for planning their first dialysis treatment were enrolled. The echocardiography and bioimpedance spectroscopy (BIS) were performed. The association between echocardiographic data and clinical values such as NT-proBNP and OH/ECW was examined.ResultsOH/ECW, which indicates relative fluid overload, was positively associated with LA dimension (r = 0.25, P = 0.007), LAVI (r = 0.32, P < 0.001), and E/e´ ratio (r = 0.38, P < 0.001). While OH/ECW was not significantly associated with echocardiographic values such as LVEDD, LVEDV, LVMI, and LVEF, NT-proBNP were significantly associated with all echocardiographic parameters. Multivariate logistic regression analysis showed E/e´ ratio (odds ratio, 1.14 [95% confidence interval (CI), 1.01 to 1.29]; P = 0.031), NT-proBNP (odds ratio, 4.78 [95% CI, 1.51 to 15.11]; P = 0.008), and albumin (odds ratio, 0.22 [95% CI, 0.08 to 0.66]; P = 0.007) were significantly associated with OH/ECW.ConclusionsSince OH/ECW measured by BIS is associated with echocardiographic parameters related to diastolic dysfunction, preliminary screening through laboratory findings, including serum albumin in conjunction with OH/ECW and NT-proBNP, may find patient with risk of diastolic dysfunction. Our study suggests that a timely detection of fluid overload in patients with CKD as well as their proper treatment may help reduce diastolic dysfunction. Further research may be needed to validate the consistency of this association across other stages of CKD.
Highlights
Detection of cardiac abnormalities in patient with chronic kidney diseases (CKD) can prompt early intervention and may result in improvements in cardiac prognosis
While overhydration value (OH)/extracellular water (ECW) was not significantly associated with echocardiographic values such as LVEDD, LVEDV, LV mass index (LVMI), and LV ejection fraction (LVEF), NT-proBNP were significantly associated with all echocardiographic parameters
Since OH/ECW measured by bioimpedance spectroscopy (BIS) is associated with echocardiographic parameters related to diastolic dysfunction, preliminary screening through laboratory findings, including serum albumin in conjunction with OH/ECW and NT-proBNP, may find patient with risk of diastolic dysfunction
Summary
Detection of cardiac abnormalities in patient with chronic kidney diseases (CKD) can prompt early intervention and may result in improvements in cardiac prognosis. NT-proBNP, which has been used as a biomarker for heart failure in the general population, was found to be elevated in CKD patients due to decreased renal excretion [1]. The use of NT-proBNP alone in screening for cardiac structural and functional abnormalities in CKD patients is not currently recommended, because there is no cut-off value recommended for different stage of CKD. Echocardiography is the most appropriate monitoring tool for patients with CKD [2]. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend echocardiograms for all patients at the initiation of dialysis (ideally within 1–3 months of dialysis initiation) and at 3-yearly intervals thereafter [3]. There are no such guidelines for dialysis naive patients with renal insufficiency
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