NDT Advance Access originally published online on August 17, 2007
Nephrology Dialysis Transplantation 2008 23(1):239-248; doi:10.1093/ndt/gfm542
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Cardiovascular remodelling and extracellular fluid excess in early stages of chronic kidney disease
1Néphrologie, AP-HP, Hôpital Bichat Claude Bernard, 2Inserm U699, 3Physiologie- Explorations-Fonctionnelles, AP-HP, Hôpital Bichat Claude Bernard, 4Inserm U772, 5Inserm U698 and Service d’Explorations Fonctionnelles, Hôpital Notre-Dame du Perpétuel Secours, Levallois-Perret, 6Association pour l’Utilisation du Rein Artificiel (AURA) and 7Département d’Epidémiologie, Biostatistique et Recherche Clinique, AP-HP, Hôpital Bichat Claude Bernard, Paris, France
Correspondence to: Dr Marie Essig, Service de Néphrologie, AP-HP, Hopital Bichat, 46 rue Henri Huchard, 75018 Paris, France, Email: essig{at}bichat.inserm.fr
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Abstract |
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Backgound. Patients with a mild to moderate decrease of glomerular filtration rate (GFR) are at risk of cardiovascular (CV) events and CV remodelling has been demonstrated in patients with advanced chronic kidney disease (CKD). However, early stages of CKD and the mechanisms involved in these modifications have not been studied.
Methods. A total of 104 patients with early CKD (mean GFR 60 ± 21 ml/min/1.73 m2) had cardiac and vascular ultrasound study and measurement of extracellular fluid by multifrequence spectroscopic bioimpedance.
Results. GFR decline was associated with left ventricular (LV) remodelling or hypertrophy in 58 and 68% of DOQI-2 and DOQI-3 patients, respectively and impaired LV diastolic function. GFR decrease was also associated with common carotid remodelling and increased aorta stiffness. Cardiac and vascular remodelling were significantly associated with an excess of extracellular fluid (ECFe) evidenced as early as DOQI-2 stage. In multivariate analysis with adjustment for GFR, ECFe, age and systolic blood pressure (sBP), GFR was no longer independently associated with cardiac and vascular remodelling, whereas ECFe was an independent determinant of LV hypertrophy, left atrium enlargement, common carotid diameter and intima media thickness.
Conclusion. This study shows that CV remodelling and ECF excess occurred at a very early stage of CKD. The independent association between ECF excess and cardiac and vascular remodelling and hypertrophy may be instrumental in the increased cardiovascular risk in CKD patients. Early therapeutic control of ECF may reduce CV events in CKD patients.
Keywords: cardiovascular remodelling; chronic kidney disease; extracellular fluid; hypervolaemia
The authors wish it to be known that, in their opinion, the first two authors contributed equally to this work.
Received for publication: 25. 2.07
Accepted in revised form: 17. 7.07