Assessing Heart Function in Asymptomatic Patients with Chronic Kidney Disease

Abstract

Heart-kidney interaction plays a crucial role in the development of chronic kidney disease and its cardiovascular complications, commonly referred to as cardiorenal syndrome. In cardiorenal syndrome, chronic kidney disease contributes to cardiovascular dysfunction through mechanisms like pressure overload, volume overload, and non-hemodynamic factors, including inflammation, oxidative stress, and inappropriate activation of the renin-angiotensin system. These factors lead to myocardial remodeling, left ventricular hypertrophy, diastolic dysfunction, and myocardial fibrosis, resulting in increased left ventricular filling pressures and impaired cardiac function.

Echocardiography, particularly through the use of global longitudinal strain, has become a valuable tool for assessing myocardial dysfunction in chronic kidney disease patients. Global longitudinal strain is a sensitive biomarker for early detection of subclinical cardiac dysfunction, even in patients with preserved ejection fraction and no overt cardiovascular symptoms. Impaired GLS has been linked to an increased risk of major adverse cardiovascular events in chronic kidney disease patients, serving as an early indicator of myocardial injury associated with cardiorenal syndrome.

Recent research has highlighted the importance of heart-kidney interaction and the emerging concept of cardiovascular–kidney–metabolic syndrome, which emphasizes the interplay between metabolic risk factors, chronic kidney disease, and cardiovascular disease. Incorporating global longitudinal strain measurements into clinical practice, alongside traditional echocardiographic assessments, can improve the early detection and management of cardiorenal syndrome, allowing for timely interventions that reduce the risk of heart failure and cardiovascular events. Early identification and monitoring of global longitudinal strain may help mitigate long-term cardiovascular risk and improve patient outcomes.

Keywords: Heart-kidney interaction, Chronic Kidney Disease, Echocardiography, Cardiorenal Syndrome, Global Longitudinal strain