The progression of chronic kidney disease (CKD) to kidney failure
(end-stage renal disease or ESRD) is associated with less
eficient pumping of blood by the heart. This decline in
the “ejection fraction”—the amount of blood that leaves
the heart with each contraction versus the amount that
is left behind—may contribute to the increased risk of
cardiovascular disease and death that is seen in patients
who are undergoing dialysis. These indings come from
the Chronic Renal Insuficiency Cohort (CRIC) Study,
one of the largest and longest ongoing studies of CKD
epidemiology in the United States.
In the current report, CRIC researchers focused on a
subset of patients who had progressed from advanced
CKD to ESRD over the course of the study, and
who had undergone an echocardiogram—a test that
produces a detailed moving image of a beating heart—
both while they had advanced CKD and shortly after
they had progressed to ESRD. These tests provided
detailed “before” and “after” information about the
patients’ heart structure and function as their kidney
Nearly three-quarters of patients with advanced CKD
or ESRD have a condition termed left ventricular
hypertrophy, which means that the main pumping
chamber of their hearts is larger than normal because it
must work harder to pump blood throughout the body.
The researchers noted that there was no difference in
the degree of left ventricular hypertrophy as patients
progressed from advanced CKD to ESRD. However,
the average ejection fraction decreased slightly, but
signiicantly, during the transition to ESRD. This was
observed across all patients regardless of their age, race,
diabetes status, or the type of dialysis (hemodialysis or
peritoneal dialysis) they were receiving.
This is the irst study to examine changes in heart
structure and function in patients as they progress
from CKD to ESRD. Future studies will explore the
mechanisms responsible for the decline in ejection
fraction that accompanies progression to ESRD.
Bansal N, Keane M, Delafontaine P, et al. A longitudinal study
of left ventricular function and structure from CKD to ESRD:
the CRIC study. Clin J Am Soc Nephrol 8: 355-362, 2013.