Journal Article

Cardiovascular remodelling and extracellular fluid excess in early stages of chronic kidney disease

Marie Essig, Brigitte Escoubet, Dominique de Zuttere, Françoise Blanchet, Florence Arnoult, Emmanuel Dupuis, Catherine Michel, Françoise Mignon, France Mentre, Christine Clerici and François Vrtovsnik

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 23, issue 1, pages 239-248
Published in print January 2008 | ISSN: 0931-0509
Published online August 2007 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfm542
Cardiovascular remodelling and extracellular fluid excess in early stages of chronic kidney disease

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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

Journal Article.  5458 words.  Illustrated.

Subjects: Nephrology

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