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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2021  |  Volume : 32  |  Issue : 1  |  Page : 273-275
The Left Atrial Volume Index as an Indicator of Left Atrial Remodeling in Chronic Kidney Disease


Department of Internal and Occupational Diseases and Rheumatology, Sechenov First Moscow State Medical University, Moscow, Russian Federation, Russian

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Date of Web Publication16-Jun-2021
 

How to cite this article:
Rudenko T, Kamyshova E, Bobkova I. The Left Atrial Volume Index as an Indicator of Left Atrial Remodeling in Chronic Kidney Disease. Saudi J Kidney Dis Transpl 2021;32:273-5

How to cite this URL:
Rudenko T, Kamyshova E, Bobkova I. The Left Atrial Volume Index as an Indicator of Left Atrial Remodeling in Chronic Kidney Disease. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2021 Dec 4];32:273-5. Available from: https://www.sjkdt.org/text.asp?2021/32/1/273/318540


To the Editor,

Left chamber heart remodeling is a common disorder in chronic kidney disease (CKD). In the last few years, it has been shown that left atrial (LA) dilatation is an independent predictor of adverse cardiovascular outcomes in patients with CKD.[1],[2] However, the most accurate echocardiographic parameters providing diagnostic and prognostic information about LA structural and functional remodeling in CKD have not been established yet.

Recently, Bokhari et al[3] studied the association between CKD and LA volume index (LAVi), one of the important indicators of diastolic dysfunction that is associated with increased mortality both in CKD and general populations and patients with hypertension. In this case-control study which included 69 patients with CKD [estimated glomerular filtration rate (eGFR) <60 mL/min] and 101 individuals without CKD, the authors revealed a significant inverse correlation between eGFR and LAVi. Nevertheless, it should be noted that, unlike individuals without CKD patients with CKD were older, more often had hypertension, ischemic heart disease and diabetes mellitus.

In the study by El-Sherbeny and Elhefnawy[4] who investigated the value of LA volume and function in early CKD patients with coexistent of hypertension, LAVi was significantly higher in early CKD and hypertensive groups compared to the controls, with no significant difference between CKD and hypertensive group. The authors concluded that LAVi reflects the effects of hypertension itself, regardless of the presence or absence of CKD.

In a previous study from Nakanishi et al,[5] patients with CKD were also older and more often had hypertension, but there was no significant difference in LAVi between the CKD and non-CKD groups. At the same time, a multivariate regression analysis revealed a significant association of eGFR with LA emptying fraction, measure of LA reservoir function, regardless of age, LV mass index, and diastolic dysfunction. Authors suggested LA enlargement was a late marker of LA remodeling.

Thus, while Bokhari et al have shown the association between CKD/eGFR and LAVi, high prevalence of hypertension, ischemic heart disease, and diabetes mellitus in CKD group, the fact that any of these could affect the LA volume necessitates multivariate analysis to clarify the significance of LAVI as sensitive parameter for assessment myocardial involvement in CKD.

Conflict of interest: None declared.



 
   References Top

1.
Tripepi G, Benedetto FA, Mallamaci F, Tripepi R, Malatino L, Zoccali C. Left atrial volume monitoring and cardiovascular risk in patients with end-stage renal disease: A prospective cohort study. J Am Soc Nephrol 2007;18:1316-22.  Back to cited text no. 1
    
2.
Chen SC, Chang JM, Liu WC, et al. Echo-cardiographic parameters are independently associated with increased cardiovascular events in patients with chronic kidney disease. Nephrol Dial Transplant 2012;27:1064-70.  Back to cited text no. 2
    
3.
Bokhari SR, Mansur A, Khan Assir MZ, Ittifaq A, Sarwar S. Echocardiographic evaluation of left atrial volume index in patients with chronic kidney disease. Saudi J Kidney Dis Transpl 2020;31:750-8.  Back to cited text no. 3
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4.
El-Sherbeny WS, Elhefnawy SB. Left atrial function and volume an independent markers of cardiovascular involvement in early chronic kidney disease. Int J Cardiovasc Res 2019;8:2.  Back to cited text no. 4
    
5.
Nakanishi K, Jin Z, Russo C, et al. Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study. Eur J Prev Cardiol 2017;24:392-8.  Back to cited text no. 5
    

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Correspondence Address:
Elena Kamyshova
Department of Internal and Occupational Diseases and Rheumatology, Sechenov First Moscow State Medical University, Moscow
Russian
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DOI: 10.4103/1319-2442.318540

PMID: 34145147

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