Cardiomyopathy in Chronic Kidney Disease and in End-stage Renal Disease

Abstract

Cardiovascular disease contributes to about 50% of overall mortality in end-stage renal disease (ESRD) patients. Alterations in left ventricular mass (LVM) and geometry and LV dysfunction are commonly prevalent and represent the strongest death predictors in this high-risk population. Although more refined techniques based on magnetic resonance imaging (MRI) are available, quantitative echocardiography is the most frequently used means of evaluating abnormalities in LVM and function. Echocardiography allows detailed examination of the pericardium, valvular apparatus, atria and ventricles, as well as reasonably reliable quantification of LVM and function. This technique also provides information on LV geometry, i.e., it identifies the pattern of cardiac remodelling (eccentric or concentric) and allows estimation of LV function during systolic and diastolic phases of the cardiac cycle. The vast majority of studies on cardiomyopathy in ESRD are observational in nature, and the number of controlled clinical trial in these patients is very small. Beta blockers (carvedilol) and angiotensin receptors blockers improve LV performance and reduce mortality in ESRD patients with LV dysfunction. Conversion to nocturnal dialysis and perhaps to short, daily dialysis produces a marked improvement in LV hypertrophy (LVH) in ESRD patients. Nocturnal dialysis appears recommendable in dialysis patients with asymptomatic or symptomatic LV disorders wherever the needed organizational and financial resources exist.