Mavrakanas Thomas A, Khattak Aisha, Singh Karandeep, Charytan David M
Renal Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada.
BMC Nephrol. 2018 Jul 11;19(1):176. doi: 10.1186/s12882-018-0975-5.
Echocardiographic characteristics across the spectrum of chronic kidney disease (CKD) have not been well described. We assessed the echocardiographic characteristics of patients with preserved renal function and mild or moderate CKD referred for echocardiography and determined whether echocardiographic parameters of left ventricular (LV) and right ventricular (RV) structure and function were associated with changes in renal function and mortality.
This retrospective cohort study enrolled all adult patients who had at least one trans-thoracic echocardiography between 2004 and 2014 in our institution. The composite outcome of doubling of serum creatinine or initiation of maintenance dialysis or kidney transplantation was the primary outcome. Mortality was the secondary outcome.
29,219 patients were included. Patients with worse renal function had higher prevalence of structural and functional LV and RV abnormalities. Higher estimated glomerular filtration rate (eGFR) was independently associated with preserved LV ejection fraction, preserved RV systolic function, and lower LV mass, left atrial diameter, pulmonary artery pressure, and right atrial pressure, as well as normal RV structure. 1041 composite renal events were observed. 8780 patients died during the follow-up. Pulmonary artery pressure and the RV, but not the LV, echocardiographic parameters were independently associated with the composite renal outcome. In contrast, RV systolic function, RV dilation or hypertrophy, LV ejection fraction group, LV diameter quartile, and pulmonary artery pressure quartile were independently associated with all-cause mortality.
Echocardiographic abnormalities are frequent even in early CKD. Echocardiographic assessment particularly of the RV may provide useful information for the care of patients with CKD.
慢性肾脏病（CKD）各阶段的超声心动图特征尚未得到充分描述。我们评估了因超声心动图检查而就诊的肾功能正常及轻度或中度CKD患者的超声心动图特征，并确定左心室（LV）和右心室（RV）结构及功能的超声心动图参数是否与肾功能变化及死亡率相关。
这项回顾性队列研究纳入了2004年至2014年期间在我院至少接受过一次经胸超声心动图检查的所有成年患者。血清肌酐翻倍或开始维持性透析或肾移植的复合结局为主要结局。死亡率为次要结局。
共纳入29219例患者。肾功能较差的患者左心室和右心室结构及功能异常的患病率更高。较高的估计肾小球滤过率（eGFR）与左心室射血分数保留、右心室收缩功能保留、较低的左心室质量、左心房直径、肺动脉压和右心房压以及正常的右心室结构独立相关。观察到1041例复合肾脏事件。8780例患者在随访期间死亡。肺动脉压以及右心室而非左心室的超声心动图参数与复合肾脏结局独立相关。相比之下，右心室收缩功能、右心室扩张或肥厚、左心室射血分数分组、左心室直径四分位数和肺动脉压四分位数与全因死亡率独立相关。
即使在CKD早期，超声心动图异常也很常见。对右心室进行超声心动图评估可能为CKD患者的护理提供有用信息。
