Abstract
Type 2 Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD) worldwide, and is associated with an increased risk of left ventricular (LV) hypertrophy, LV systolic and diastolic dysfunctions. The aim of this study was to investigate abnormal echocardiographic findings in patients with CKD with and without DM, and identify the factors associated with these abnormalities. We enrolled 356 pre-dialysis patients with CKD (stages 3–5), including 208 with DM and 148 without DM. The structure and systolic and diastolic functions of the left ventricle were assessed using echocardiography, and the clinical and echocardiographic parameters were analyzed. The patients with DM had higher rates of observed/predicted left ventricular mass > 128% (69.5% vs. 56.7%, p = 0.015), midwall fractional shortening < 14% (22.6% vs. 8.8%, p = 0.001), and ratio of peak early transmitral filling wave velocity to early diastolic velocity of lateral mitral annulus > 12 (32.7% vs. 16.2%, p < 0.001) than those without DM. Multivariate analysis showed that male sex, a history of smoking, high systolic blood pressure, high body mass index, high levels of fasting glucose and total cholesterol, low levels of albumin and hemoglobin, and a low estimated glomerular filtration rate were associated with abnormal echocardiographic findings. The rates of inappropriate left ventricular mass, systolic and diastolic dysfunction were higher in our patients with CKD and DM than in those without DM.
Highlights
Type 2 diabetes mellitus (DM) is the major cause of chronic kidney disease (CKD) worldwide, and in Taiwanese patients undergoing dialysis it accounts for around 45% of cases of end-stage renal disease
The results showed that high body mass index (BMI) and low estimated glomerular filtration rate were significantly associated with observed/predicted left ventricular (LV) mass (LVM) > 128% after adjusting for age, sex, a history of smoking, HTN, coronary artery disease (CAD), cerebrovascular disease, systolic and diastolic blood pressure (BP), BMI, albumin, fasting glucose, triglycerides, total cholesterol, hemoglobin, eGFR, calcium-phosphorous (CaXP) product, uric acid, proteinuria, and the use of medications including angiotensin converting enzyme inhibitor (ACEI), angiotensin II receptor blocker (ARB), β-blockers, calcium channel blockers and diuretics
We compared echocardiographic abnormalities among patients with CKD stage 3–5 with and without Diabetes mellitus (DM), and evaluated the factors associated with these abnormalities in the patients with DM
Summary
Type 2 diabetes mellitus (DM) is the major cause of chronic kidney disease (CKD) worldwide, and in Taiwanese patients undergoing dialysis it accounts for around 45% of cases of end-stage renal disease. Structural and functional abnormalities of the heart have frequently been reported in patients with renal insufficiency due to pressure and volume overload [3, 4]. Patients with CKD have been associated with high rates of impaired left ventricular (LV) systolic and diastolic function and LV hypertrophy (LVH) [3, 4]. In patients with DM, the most common types of structural and functional heart disease are coronary artery disease (CAD) and diabetic cardiomyopathy, as characterized by LVH, and LV systolic and diastolic dysfunction [5]. Few studies have compared echocardiographic abnormalities in patients with moderate to advanced CKD with and without DM. The aims of this study were to compare echocardiographic abnormalities in this population, and evaluate factors associated with these abnormalities in the patients with DM
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