Prevalence of diastolic dysfunction according to 2016 ASE/EACVI criteria in non-dialysis chronic kidney disease patients

Background

Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. Left ventricular (LV) diastolic dysfunction (DD) represents an early manifestation of cardiac involvement in CKD; however, its true prevalence independent of overt cardiovascular disease remains insufficiently characterized.

Objective

To determine the prevalence of LV diastolic dysfunction according to the 2016 American Society of Echocardiography / European Association of Cardiovascular Imaging criteria in a non-dialysis CKD population predominantly comprising early and intermediate disease stages, after exclusion of concomitant cardiac and systemic conditions that may confound diastolic assessment.

Methods

This cross-sectional study included 300 non-dialysis CKD patients with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m². Patients underwent comprehensive clinical, laboratory, and transthoracic echocardiographic evaluation. Diastolic function was assessed using the 2016 ASE/EACVI algorithm based on septal or lateral e′ velocity, average E/e′ ratio, left atrial volume index, and tricuspid regurgitation jet velocity. Diastolic function was categorized as normal (≤1 abnormal parameter), indeterminate (2 parameters), or definite DD (≥3 parameters). Patients with dialysis therapy, prior renal transplantation, significant valvular disease, coronary artery disease, reduced LVEF (<50%), heart failure, cardiomyopathy, pulmonary embolism, or constrictive pericarditis were excluded.

Results

The mean age of the study population was 63.4 ± 12.2 years, and 59.3% of patients were female. Chronic kidney disease stages were distributed as follows: G3a 42.7% (n=128), G3b 32.3% (n=97), G4 19.0% (n=57), and G5 6.0% (n=18). Hypertension was the most prevalent comorbidity (86%), followed by diabetes mellitus (38%).

Baseline clinical characteristics according to CKD stage are summarized in Table 1. Age differed significantly across CKD stages (p=0.021), whereas sex distribution, body mass index, and the prevalence of major cardiovascular comorbidities—including hypertension, diabetes mellitus, and atrial fibrillation—were comparable among groups (all p>0.05).

According to the 2016 ASE/EACVI criteria, definite diastolic dysfunction was identified in 6.7% of patients (n=20), indeterminate diastolic function in 26.7% (n=80), and normal diastolic function in 66.6% (n=200) (Figure 1).

Conclusion

In a carefully selected non-dialysis CKD population free of overt cardiovascular disease, LV diastolic dysfunction was identified in a substantial proportion of patients, even at early and intermediate CKD stages. These findings suggest that CKD itself may contribute to subclinical impairment of LV diastolic function, independent of established cardiac pathology. Systematic diastolic function assessment in early-stage CKD may therefore facilitate earlier detection of cardiac involvement and improve cardiovascular risk stratification.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.