Effect of diabetes mellitus on markers of left ventricular dysfunction in chronic kidney disease

OBJECTIVES: To identify markers of left ventricular dysfunction in chronic kidney disease (CKD) and the effects of diabetes mellitus on them. METHODS: This was a cross sectional study of 200 consecutive chronic kidney disease patients (stage III-V). Echocardiographic assessment of left ventricular function including left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), left atrial volume, grade of diastolic dysfunction, E/E’, left and right ventricular myocardial performance indices (LVMPI, RVMPI) were compared between diabetic and non-diabetic CKD. RESULTS: LVMI significantly increased with increasing stage of CKD (p < 0.001) in both diabetics (158.82 ± 48.76 gm/m(2) in stage III to 201.06 ± 63.62 gm/m(2) in stage V) and non-diabetics (133.14 ± 43.06 gm/m(2) stage III to 196.24 ± 58.75 gm/m(2) in stage V). This was significantly higher among diabetics of similar CKD stage compared to non-diabetics (p = 0.001). The LVEF worsened with increasing stage of CKD (p = 0.002) and was significantly reduced in diabetic patients (LVEF 61.96 ± 8.48 % in stage III CKD to 51.62 ± 13.45 % in stage V CKD) (p < 0.001). Diastolic dysfunction (Grades ≥2) and LA volume increased significantly with stage of CKD (p < 0.001) and was higher among diabetics (p = 0.048). Pulmonary artery systolic pressure (PASP) increased with increasing stage of CKD (p < 0.001), and was higher among diabetics (p = 0.035). E/E’ worsened significantly with increasing stage of CKD and was also significantly higher in diabetics (p < 0.001). LVMPI (p < 0.001) and RVMPI (p < 0.001) were significantly reduced with worsening stage of CKD and in diabetics. CONCLUSION: Advancing CKD stage was linearly associated with progressive left ventricular dysfunction which was significantly greater in diabetics.