title: Cardiovascular remodelling and extracellular fluid excess in early stages of chronic kidney disease.
abstract: BACKGROUND
  Patients with a mild to moderate decrease of glomerular filtration rate (GFR) are at risk of cardiovascular (CV) events and CV remodelling has been demonstrated in patients with advanced chronic kidney disease (CKD). However, early stages of CKD and the mechanisms involved in these modifications have not been studied.
  
  
  METHODS
  A total of 104 patients with early CKD (mean GFR 60+/-21 ml/min/1.73 m(2)) had cardiac and vascular ultrasound study and measurement of extracellular fluid by multifrequence spectroscopic bioimpedance.
  
  
  RESULTS
  GFR decline was associated with left ventricular (LV) remodelling or hypertrophy in 58 and 68% of DOQI-2 and DOQI-3 patients, respectively and impaired LV diastolic function. GFR decrease was also associated with common carotid remodelling and increased aorta stiffness. Cardiac and vascular remodelling were significantly associated with an excess of extracellular fluid (ECFe) evidenced as early as DOQI-2 stage. In multivariate analysis with adjustment for GFR, ECFe, age and systolic blood pressure (sBP), GFR was no longer independently associated with cardiac and vascular remodelling, whereas ECFe was an independent determinant of LV hypertrophy, left atrium enlargement, common carotid diameter and intima media thickness.
  
  
  CONCLUSIONS
  This study shows that CV remodelling and ECF excess occurred at a very early stage of CKD. The independent association between ECF excess and cardiac and vascular remodelling and hypertrophy may be instrumental in the increased cardiovascular risk in CKD patients. Early therapeutic control of ECF may reduce CV events in CKD patients.
authors: Néphrologie, AP-HP, Hopital Bichat Claude Bernard, Paris, France. essig@bichat.inserm.fr
authors: Marie
authors: M
authors: Essig
authors: Brigitte
authors: B
authors: Escoubet
authors: Dominique
authors: D
authors: de Zuttere
authors: Françoise
authors: F
authors: Blanchet
authors: Florence
authors: F
authors: Arnoult
authors: Emmanuel
authors: E
authors: Dupuis
authors: Catherine
authors: C
authors: Michel
authors: Françoise
authors: F
authors: Mignon
authors: France
authors: F
authors: Mentre
authors: Christine
authors: C
authors: Clerici
authors: François
authors: F
authors: Vrtovsnik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002319:Cardiovascular System / Q000503:physiopathology*; D002908:Chronic Disease; D018450:Disease Progression; D045604:Extracellular Fluid; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged