Fluid overload is a determinant for cardiac structural and functional impairments in type 2 diabetes mellitus and chronic kidney disease stage 5 not undergoing dialysis

• Published in: PloS one 2020-07, Vol.15 (7), p.e0235640-e0235640
• Main Authors: Han, Byoung-Geun, Lee, Jun Young, Kim, Mi Ryung, Shin, Hanwul, Kim, Jae-Seok, Yang, Jae-Won, Kim, Jong Yeon
• Format: Article
• Language: English
• Subjects: Abnormalities; Biology and Life Sciences; Blood pressure; Body mass index; Brain natriuretic peptide; Cardiovascular disease; Cardiovascular diseases; Cardiovascular system; Congestive heart failure; Continuity (mathematics); Coronary artery disease; Coronary vessels; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Dialysis; Echocardiography; End-stage renal disease; Evaluation; Heart diseases; Hemodialysis; Hypertension; Hypertrophy; Kidney diseases; Kidneys; Laboratories; Medical schools; Medicine; Medicine and Health Sciences; Mortality; Nephrology; Overloading; Pathophysiology; Patients; Physical Sciences; Regression analysis; Research and Analysis Methods; Risk factors; Spectroscopy; Structure-function relationships; Ventricle
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0235640

Background Fluid overload is common in patients with diabetes and chronic kidney disease (DM and CKD; DMCKD) and can lead to structural and functional cardiac abnormalities including left ventricular hypertrophy (LVH) and left ventricular diastolic dysfunction (LVDD). Fluid overload represents a crucial step in the pathophysiological pathways to chronic heart failure in patients with end-stage renal disease. We evaluated the impact of fluid overload on cardiac alterations in patients with diabetes and non-dialysis-dependent CKD stage 5 (DMCKD5-ND) without intrinsic heart disease. Methods Bioimpedance spectroscopy, echocardiography, and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) measurement were performed in 135 consecutive patients on the same day. Patients were divided into groups by tertiles of overhydration/extracellular water (OH/ECW) per bioimpedance spectroscopy. Results Fluid balance markers including OH/ECW and NT-proBNP were significantly higher in the LVDD+LVH group. OH/ECW and its exacerbation were positively associated with the ratio between early mitral inflow and annular early diastolic velocities (E/e′ ratio) and left ventricular mass index (LVMI). The prevalence of LVH progressively increased across increasing tertiles of OH/ECW. In multiple regression analyses, OH/ECW as a continuous and categorical variable was independently associated with the E/e′ ratio and LVMI after adjustment for multiple confounding factors. Conclusions Fluid overload was independently associated with LVDD and LVH in patients with DMCKD5-ND. Our study suggests that structural and functional cardiac abnormalities and volume status should be evaluated simultaneously in patients with early-stage DMCKD rather than only DMCKD5-ND, in addition to intensive blood pressure and glycemic control, regardless of evident cardiovascular disease.