Left ventricular dysfunction with preserved ejection fraction: the most common left ventricular disorder in chronic kidney disease patients

Mark, P. B. , Mangion, K., Rankin, A. J. , Rutherford, E., Lang, N. N. , Petrie, M. C. , Stoumpos, S. and Patel, R. K. (2022) Left ventricular dysfunction with preserved ejection fraction: the most common left ventricular disorder in chronic kidney disease patients. Clinical Kidney Journal, 15(12), pp. 2186-2199. (doi: 10.1093/ckj/sfac146) (PMID:36381379) (PMCID:PMC9664574)

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Chronic kidney disease (CKD) is a risk factor for premature cardiovascular disease. As kidney function declines, the presence of left ventricular abnormalities increases such that by the time kidney replacement therapy is required with dialysis or kidney transplantation, more than two-thirds of patients have left ventricular hypertrophy. Historically, much research in nephrology has focussed on the structural and functional aspects of cardiac disease in CKD, particularly using echocardiography to describe these abnormalities. There is a need to translate knowledge around these imaging findings to clinical outcomes such as unplanned hospital admission with heart failure and premature cardiovascular death. Left ventricular hypertrophy and cardiac fibrosis, which are common in CKD, predispose to the clinical syndrome of heart failure with preserved left ventricular ejection fraction (HFpEF). There is a bidirectional relationship between CKD and HFpEF, whereby CKD is a risk factor for HFpEF and CKD impacts outcomes for patients with HFpEF. There have been major improvements in outcomes for patients with heart failure and reduced left ventricular ejection fraction as a result of several large randomized controlled trials. Finding therapy for HFpEF has been more elusive, although recent data suggest that sodium-glucose cotransporter 2 inhibition offers a novel evidence-based class of therapy that improves outcomes in HFpEF. These observations have emerged as this class of drugs has also become the standard of care for many patients with proteinuric CKD, suggesting that there is now hope for addressing the combination of HFpEF and CKD in parallel. In this review we summarize the epidemiology, pathophysiology, diagnostic strategies and treatment of HFpEF with a focus on patients with CKD.

Item Type:Articles
Additional Information:A.R. is personally funded by a Clinical Academic Training Fellowship from the Chief Scientist Office (Scotland; CAF/18/02). E.R. is supported by a post-doctoral Clinical Lectureship from the Chief Scientist Office (Scotland; PCL/03/18). The work was additionally funded by British Heart Foundation Clinical Research Training Fellowships to K.M. (FS/15/54/31639), R.P. and P.B.M.
Glasgow Author(s) Enlighten ID:Patel, Dr Rajan and Mark, Professor Patrick and Stoumpos, Dr Sokratis and Petrie, Professor Mark and Lang, Professor Ninian and Mangion, Dr Kenneth and Rankin, Dr Alastair and Rutherford, Dr Elaine
Authors: Mark, P. B., Mangion, K., Rankin, A. J., Rutherford, E., Lang, N. N., Petrie, M. C., Stoumpos, S., and Patel, R. K.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Clinical Kidney Journal
Publisher:Oxford University Press
ISSN (Online):2048-8513
Published Online:25 May 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Clinical Kidney Journal 15(12): 2186-2199
Publisher Policy:Reproduced under a Creative Commons License

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