Echocardiographic Assessment of Structure and Function of Left Ventricle in Chronic Kidney Disease Along with its Determinants in a Tertiary Healthcare Center in Tribal Region of Jharkhand.

Abstract

Introduction: Chronic kidney disease (CKD) is a complex pathophysiologic process that leads to irreversible changes in kidney structure and function. The left ventricle (LV) remodeling, which is evident as LV hypertrophy (LVH) is highly prevalent in patients with CKD even in the early stages and has a strong association with cardiovascular mortality, multiple studies have suggested that there is a strong association between high albuminuria and LVH, which was found to be independent of low GFR, hypertension, and diabetes. The most commonly used noninvasive method for estimating cardiac function and size is 2D echocardiography. It has the benefit of being portable, available, and providing images of the heart in real time. In CKD patients, echo is the most important noninvasive method for predicting cardiovascular risk.

Materials and methods: This was a cross-sectional observational study approved by the institutional ethics committee through memo no. 210/IEC, Rajendra Institute of Medical Sciences (RIMS) dated October 3 rd , 2023. The study was conducted on patients with CKD admitted to the Department of Internal Medicine at RIMS, Ranchi, Jharkhand between November 2023 and July 2024. Taking the prevalence of 6.3%, the sample size comes out to be 95, and we have taken 114 patients for our study. Data were collected using Google Forms, and a template was generated in an Microsoft Excel sheet. SPSS software version 22.0 and JAMOVI software version 2.3 were used for data analysis. A Chi-square test with Fisher's exact test for cells <5 was applied for the test of significance between variables. A multivariate analysis was performed for associations between variables. P ≤0.05 was considered statistically significant.

Results: The study was conducted on 114 patients, of whom 69% were males and 31% were females. Among comorbidities, hypertension, diabetes, smoking, dyslipidemia and alcohol were studied. The majority of cases (63%) belonged to CKD Stage 5 compared to other stages of CKD. Most of the cases (33%) had a moderate reduction in the LV ejection fraction (LVEF), and 52% of the cases had concentric hypertrophy. Grade 1 LV diastolic dysfunction was the most common (76%). In Stage 5 CKD, 43% of the patients had a moderate decrease in the LVEF. Using the Chi-square test, a significant association was found between CKD stages and LVEF ( P ≤ 0.023). The relationship between different variables and LVEF in the participants was evaluated, and the Chi-square test was used to determine the P value. P ≤0.05 was considered statistically significant. Alcohol, albuminuria, and dyslipidemia were found to be significant determinants of LVEF. Multinominal logistic regression analysis was applied to the above variables, and all three variables, including alcohol, albuminuria, and dyslipidemia, came out to be significant determinants of LVEF in patients with CKD.

Conclusion: Cardiovascular deaths in CKD are alarmingly high. Echo is an effective way to identify changes in the LV as the disease progresses. Diastolic dysfunction noted in CKD in its early stages can cause diastolic failure and tends to worsen with an increase in the left ventricular mass index. Attributable independent risk factors for the worsening of LV dysfunction are alcohol, albuminuria, and dyslipidemia in our study, with a significant association. The initial diagnosis of LVH, systolic and diastolic dysfunction, as well as albuminuria, and early intervention can prevent cardiac deaths in patients with CKD.