Evaluation of diastolic parameters by echocardiography in patients diagnosed with chronic kidney disease

MISGINOVA SH, Evaluation of Echocardiographic Diastolic Parameters in Patients Diagnosed with Chronic Kidney Disease, Eskişehir Osmangazi University Faculty of Medicine, Department of Cardiology, Medical Specialty Thesis, Eskişehir, 2025. Chronic kidney disease (CKD) is a condition associated with a high risk of cardiovascular (CV) morbidity and mortality. In individuals with CKD, left ventricular (LV) diastolic dysfunction (DD) is one of the important cardiac changes that can be identified at an early stage. In this study, 300 non-dialytic patients with CKD were divided into G3a (45–59 mL/min/1.73 m²; n=128), G3b (30–44 mL/min/1.73 m²; n=97), and G4–5 (<30 mL/min/1.73 m²; n=75) groups according to estimated glomerular filtration rate (eGFR) levels. Among the 275 patients in whom the albumin-to-creatinine ratio (ACR) was evaluated, A1 (<30 mg/g; n=104), A2 (30–300 mg/g; n=83), and A3 (≥300 mg/g; n=88) groups were formed. The findings were analyzed comparatively among these eGFR and ACR groups. In the study, based on the evaluation performed using the DD criteria defined by the 2016 American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI), definite DD was detected in 6.7% of patients (n=20), while indeterminate (gray zone) DD was identified in 26.7% (n=80). N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels showed statistically significant differences among the eGFR and ACR groups (p<0.001). As eGFR decreased, LV structural parameters increased significantly. In the assessment of diastolic function, septal and lateral e′ values were found to be below normal, the mitral E/A ratio was reduced, and a tendency toward early diastolic dysfunction (Grade I DD) was observed in patients. Statistically significant associations were identified between ACR and LAVI, IVRT, mitral E filling pressure, and mitral E velocity. Left atrial maximum volume (LAVmax) showed a statistically significant increase as eGFR decreased and ACR increased, while a general reduction was observed in left atrial (LA) phasic strain parameters. Right ventricular fractional area change (RVFAC) showed a significant association with eGFR. Key Words: Chronic kidney disease, Diastolic dysfunction, NT-proBNP