B- CRF : cardiovascular complications
E- 03 : Primitive hypertension
E- 03 : chronic heart failure
E- 03 : Pericarditis
Cardiac imaging in patients with chronic kidney disease
Diana Y. Y. Chiu,
Darren Green,
Nik Abidin,
Smeeta Sinha
& Philip A. Kalra
Journal : Nature Reviews Nephrology
Year : 2015 / Month : April
Volume : 11
Pages : 207–220
doi:10.1038/nrneph.2014.243
ABSTRACT
Patients with chronic kidney disease (CKD) carry a high cardiovascular risk. In this patient group,
cardiac structure and function are frequently abnormal and 74% of patients with CKD stage 5
have left ventricular hypertrophy (LVH) at the initiation of renal replacement therapy. Cardiac
changes, such as LVH and impaired left ventricular systolic function, have been associated with
an unfavourable prognosis. Despite the prevalence of underlying cardiac abnormalities,
symptoms may not manifest in many patients. Fortunately, a range of available and emerging
cardiac imaging tools may assist with diagnosing and stratifying the risk and severity of heart
disease in patients with CKD. Moreover, many of these techniques provide a better
understanding of the pathophysiology of cardiac abnormalities in patients with renal disease.
Knowledge of the currently available cardiac imaging modalities might help nephrologists to
choose the most appropriate investigative tool based on individual patient circumstances. This
Review describes established and emerging cardiac imaging modalities in this context, and
compares their use in CKD patients with their use in the general population.
COMMENTS
This review deserves attention. It contains a large amount of data, from basic echography to
sophisticated functional imaging.
Cardiovascular mortality is significantly increased in patients with chronic kidney disease (CKD)
and in those with CKD stage 5 undergoing dialysis (CKD-5D) compared with that of the general
population. The adjusted all-cause mortality rate for patients with CKD-5D is 6.3–8.2-fold greater
than for the general population, depending on age, and the most common cause of death is
cardiovascular disease.
Structural and functional cardiac abnormalities are common in patients with CKD. 70–80% of
CKD-5D patients have abnormal left ventricular (LV) structure and/or function and 74% of CKD
stage 5 (CKD-5) patients show evidence of LV hypertrophy (LVH) at the initiation of renal
replacement therapy. However, diagnosis of intrinsic cardiac disease can be complicated
because many patients with CKD are elderly or have diabetes mellitus and therefore may not
present with classic symptoms of cardiovascular disease such as chest pain.
In different clinical scenarios the first-line investigative imaging of choice is most likely the one
that is simple, readily available and poses the least risk to patients while providing adequate
information. If the first-line investigation is abnormal or inadequate then a second-line
investigation can be employed, and so forth. In some cases the investigation may not be
appropriate in all patients, such as exercise ECG or MRI, or may not be available (for example,
PET might not be available in all hospitals), in which case the next line of investigation might be
chosen.
Proposed algorithm for cardiac imaging in patients with chronic kidney disease.
To summarise:
A number of available cardiac imaging tools provide information about cardiac structure and
function in patients with renal disease.
2D echocardiography is simple and non-invasive, and is a useful first-line cardiac investigative
tool.
2D echocardiography can identify structural changes associated with poor prognosis but can be
prone to inaccuracy as some measurements are derived rather than actual dimensions.
3D echocardiography is comparable to the 'gold standard' investigative tool of cardiac MRI for
estimating left ventricular mass and volumes.
Cardiac PET and single-photon emission CT provide information on myocardial perfusion in renal
patients.
Different cardiac imaging modalities may be used in combination to provide a thorough
assessment of the cardiac status of renal patients.
Pr. Jacques CHANARD
Professor of Nephrology