Prevalence of echocardiographic abnormalities and their relationship with renal function and cardiac biomarkers in ckd stages 3–4

Background

Cardiovascular disease is the leading cause of morbidity and mortality in chronic kidney disease (CKD). Structural remodelling, left ventricular hypertrophy, diastolic dysfunction, and right heart abnormalities are common even in moderate CKD stages and reflect complex cardio–renal interactions. Serum biomarkers such as NT-proBNP and cardiac troponin may provide additional insight; however, the relationship between renal function, echocardiographic abnormalities, and biomarker levels in CKD stages 3–4 remains insufficiently defined.

Purpose

The present study evaluated the prevalence of structural and functional echocardiographic abnormalities in patients with CKD stages 3–4 and their association with renal function and cardiac biomarkers.

Methods

Outpatients with CKD stages 3–4 (eGFR 15–59 mL/min/1.73 m², CKD-EPI 2021) were prospectively recruited for multimodal CV evaluation. Exclusion criteria included dialysis, prior heart failure, congenital heart disease, pregnancy, active malignancy, and established coronary artery disease. The study was approved by the local ethics committee (no. 1797/2024). All participants provided written informed consent. Clinical evaluation, laboratory testing, and transthoracic echocardiography (TTE) were performed at enrolment according to American Society of Echocardiography / European Association of Cardiovascular Imaging (ASE/EACVI) recommendations using Philips CX50 Ultrasound System or Philips Epiq 5. Statistical analyses were performed using JASP version 0.95.4.

Results

A total of 159 participants were included in the analysis (29.6% G3a, 35.2% G3b, 35.2% G4) (Table 1).

TTE revealed a high prevalence of structural abnormalities. Concentric remodeling or hypertrophy was present in over half of the cohort (51.6%), while 96.8% met criteria for LV dilatation. 53.5% of patients presented with moderate diastolic dysfunction (ASE grade 2), and LA enlargement was a common finding. RV systolic function was mostly preserved with most patients having a low probability of pulmonary hypertension (85.3%) (Table 2).

No significant differences in the prevalence of echocardiographic findings were observed across CKD stages 3a–4 (all χ² p > 0.05), including LV geometry and function, LA enlargement, RV dysfunction, or pulmonary hypertension probability.

Spearman analysis showed no significant correlations between eGFR and LV structural parameters (SIV, PPVS, LVMI, RWT), diastolic indices (E/e’), or LA function (LAVI, LACI). NT-proBNP demonstrated a moderate inverse correlation with eGFR (ρ = −0.407, p < 0.001), whereas high-sensitivity troponin and CK-MB were not significantly associated with renal function.

Conclusion

Structural and functional cardiac abnormalities are highly prevalent in CKD stages 3–4 but do not differ across sub-stages. NT-proBNP correlates with renal function, whereas echocardiographic parameters do not show a direct association with eGFR in this population.