title: A look at the upper heart chamber: the left atrium in chronic kidney disease.
abstract: Altered left ventricular (LV) mass and function are classical hallmarks of cardiomyopathy in chronic kidney disease (CKD). The left atrium (LA), a heart chamber exquisitely sensitive to volume overload and diastolic function, is an independent predictor of death and adverse cardiovascular (CV) events in high-risk patients such as those with hypertension and/or with heart failure. In this review we focus on the relationship of LA size with LV diastolic function, and the association between LA enlargement and CV and renal outcomes in patients with CKD, including patients with end-stage renal disease. Increased LA size emerges as a powerful predictor of mortality and major adverse CV events in both end-stage and early CKD, and some studies also show a close association between enlarged LA and renal disease progression. Secondary analyses of clinical trials suggest that the LA has the potential to be elected as a surrogate end point in CKD patients but the issue remains to be tested in specifically designed clinical studies.
authors.affiliation: Nephrology, Dialysis, and Transplantation, University of Genoa, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Paoletti
authors.affiliation: Renal and Transplantation Unit and CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology*; D018450:Disease Progression; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
keywords: CKD; cardiomyopathy; clinical outcome; diastolic function; left atrium