Abstract
Background: Chronic Kidney Disease (CKD) is associated with adverse cardiac remodelling, most notably left ventricular (LV) hypertrophy and LV diastolic dysfunction, [1Dubin R. Application of echocardiographic data in patients with chronic kidney disease.Current Opinion in Nephrology and Hypertension. 2018; 27: 283-288Google Scholar, 2Hung K. Echocardiographic Characteristics of Chronic Kidney Disease: The Taiwanese Experience.Journal of Medical Ultrasound. 2015; 23: 14-16Crossref Scopus (2) Google Scholar, 3Liu Y. Su C. Song E. Tsai W. Li Y. Tsai L. Chen J. Sung J. The role of echocardiographic study in patients with chronic kidney disease.Journal of the Formosan Medical Association. 2015; 114: 797-805Crossref Scopus (10) Google Scholar] the presence of which has been associated with adverse cardiovascular outcomes [[4]Pakfetrat M. Roozbeh J. Nikoo M. Asem Z. Malekmakan L. Nikoo M. Common echocardiography findings in pretransplant dialysis patients and their associations.Hong Kong Journal of Nephrology. 2013; 15: 68-74Abstract Full Text Full Text PDF Scopus (1) Google Scholar]. Despite this, transthoracic echocardiography (TTE) is not routinely performed in this population, limiting opportunities for early effective intervention. The aim of our study was to evaluate local trends in utility of TTE studies in patients with CKD. Methods: Patients attending the Nephrology Clinics at Blacktown Hospital from Jan-2014 to Dec-2016 were evaluated. Patients who were referred for TTE studies in the course of their care were assessed and the indications for referral were categorised and evaluated. Results: 1179 patients (mean age 66.47 ± 16.88; 55% males) were assessed of which 386/1179 (33%) received TTE studies. The most common indication for TTE referral was for evaluation of dyspnoea 178/386 (46%) followed by evaluation of cardiac function following acute coronary syndrome (n = 129, 32%). In patients with dyspnoea, 147/178 (83%) patients had clinical findings of fluid overload on clinical assessment and 95/178 (53%) had findings of impaired LV systolic function (LVEF< 50%) on TTE. Other indications for TTE referral include arrhythmia (n = 30, 8%), evaluation of cardiac murmur (n = 21, 5%), pre-operative evaluation (n = 11, 3%) and sepsis (n = 26, 7%) A total of 177/386 (45.9%) patients had more than 1 TTE, with 100/386 (25.9%) having 2 or more TTE within 12 months. Conclusions: Our findings suggest that TTE studies are commonly performed in patients with CKD and for various indications, but with a significant proportion of studies occurring only after an adverse cardiovascular outcome.
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