title: A longitudinal study of left ventricular function and structure from CKD to ESRD: the CRIC study.
abstract: OBJECTIVE
  Abnormal left ventricular structure and function are associated with increased risk of adverse outcomes among patients with CKD and ESRD. A better understanding of changes in left ventricular mass and ejection fraction during the transition from CKD to ESRD may provide important insights to opportunities to improve cardiac outcomes.
  
  
  METHODS
  This was a longitudinal study of a subset of participants of the Chronic Renal Insufficiency Cohort who were enrolled from 2003 to 2007 and followed through January of 2011. Participants were included if they had serial echocardiograms performed at advanced CKD (defined as estimated GFR<20 ml/min per 1.73 m(2)) and again after ESRD (defined as need for hemodialysis or peritoneal dialysis).
  
  
  RESULTS
  A total of 190 participants (44% female, 66% black) had echocardiograms during advanced CKD and after ESRD. Mean (SD) estimated GFR at advanced CKD was 16.9 (3.5) ml/min per 1.73 m(2). Mean (SD) time between the advanced CKD echocardiogram and ESRD echocardiogram was 2.0 (1.0) years. There was no significant change in left ventricular mass index (62.3-59.5 g/m(2.7), P=0.10) between advanced CKD and ESRD; however, ejection fraction significantly decreased (53%-50%, P=0.002). Interactions for age, race, dialysis modality, and diabetes status were not significant (P>0.05).
  
  
  CONCLUSIONS
  Mean left ventricular mass index did not change significantly from advanced CKD to ESRD; however, ejection fraction declined during this transition period. Although left ventricular mass index is fixed by advanced stages of CKD, ejection fraction decline during more advanced stages of CKD may be an important contributor to cardiovascular disease and mortality after dialysis.
authors: Division of Nephrology, University of California, San Francisco, 521 Parnassus Avenue, Box 0532, San Francisco, CA 94143, USA. nisha.bansal@ucsf.edu
authors: Nisha
authors: N
authors: Bansal
authors: Martin
authors: M
authors: Keane
authors: Patrice
authors: P
authors: Delafontaine
authors: Daniel
authors: D
authors: Dries
authors: Elyse
authors: E
authors: Foster
authors: Crystal A
authors: CA
authors: Gadegbeku
authors: Alan S
authors: AS
authors: Go
authors: L Lee
authors: LL
authors: Hamm
authors: John W
authors: JW
authors: Kusek
authors: Akinlolu O
authors: AO
authors: Ojo
authors: Mahboob
authors: M
authors: Rahman
authors: Kaixiang
authors: K
authors: Tao
authors: Jackson T
authors: JT
authors: Wright
authors: Dawei
authors: D
authors: Xie
authors: Chi-yuan
authors: CY
authors: Hsu
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014463:Ultrasonography; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left