Assessment of cardiac structure and function in kidney failure: understanding echocardiography and magnetic resonance im
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NEPHROLOGY - REVIEW
Assessment of cardiac structure and function in kidney failure: understanding echocardiography and magnetic resonance imaging for the nephrologist Dharmenaan Palamuthusingam1,2,7 · Reza Reyaldeen3 · David Wayne Johnson2,4,5 · Camel M. Hawley2,4 · Elaine M. Pascoe6 · Sudhir Wahi1 · Magid Fahim2,4 Received: 17 May 2020 / Accepted: 12 August 2020 © Springer Nature B.V. 2020
Abstract Cardiovascular disease is the leading cause of death in patients with kidney failure or on chronic dialysis. Patients on chronic dialysis have a 10- to 50-fold increased risk of sudden cardiac death compared to patients with normal kidney function. Adverse changes in cardiac structure and function may not manifest with clinical symptoms in patients with kidney failure and, therefore, pose a challenge in identifying cardiac dysfunction early. Fortunately, there are multi-modality cardiac imaging techniques available, including echocardiography and cardiac magnetic resonance imaging, that can help our understanding of the pathophysiology of cardiac dysfunction in kidney failure. This review describes the benefits and limitations of these two commonly available cardiac imaging modalities to assess cardiac structure and function, thereby aiding nephrologists in choosing the most appropriate investigative tool based on individual clinical circumstances. For the purposes of this review, cardiac imaging for detection of coronary artery disease has been omitted. Keywords Chronic dialysis · End-stage kidney disease · Cardiomyopathy
Background Cardiovascular disease is the leading cause of death in patients with kidney failure with an associated mortality rate ranging between 7.9 and 9.9 deaths per 100 patient years [1]. It accounts for at least 43% of all deaths in this patient group and is the underlying reason for withdrawal from dialysis therapy in over 25% of patients [1]. Compared to patients
with normal kidney function, dialysis patients have a 10to 50-fold increased risk of sudden cardiac death [2]. The underlying pathologies predisposing to sudden cardiac death appear to differ between the general and dialysis population, with the former being primarily attributed to ischaemic cardiac disease and the latter attributed to cardiomyopathic changes and conduction system disturbances [3]. Furthermore, cardiac dysfunction often presents with atypical 1
Reza Reyaldeen [email protected]
Metro South and Integrated Nephrology and Transplant Services, Logan Hospital, Armstrong Road & Loganlea Road, Meadowbrook, QLD 4131, Australia
2
David Wayne Johnson [email protected]
Faculty of Medicine, University of Queensland, St Lucia, QLD 4072, Australia
3
Camel M. Hawley [email protected]
Cardiovascular Imaging Section, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
4
Metro South and Integrated Nephrology and Transplant Services, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
5
Translational Research Institute, Brisba
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