Cardiac remodeling in patients with diabetes mellitus and chronic kidney disease

Objective: To study the features of cardiac remodeling in patients with diabetes mellitus (DM) depending on the stage of chronic kidney disease (CKD). Design and method: We examined 499 patients with type 1 and type 2 diabetes mellitus older than 25 years. The laboratory examination of the patients included the measurement of serum creatinine, eGFR according to the CKD-EPI equation. An echocardiographic investigation was performed to study structural and geometric heart parameters. Left ventricular hypertrophy (LVH) was diagnosed when the left ventricular myocardial mass index (LVMI) exceeded 115 g/m2 in men and 95 g/m2 in women. Results: LVH was detected in 57.7% of patients with DM, while in the comparison group – in 35.4%. The frequency of LVH increased with a decrease in eGFR and was diagnosed in 100% of cases with CKD 5. In patients with DM, the left ventricular concentric remodeling significantly predominated (29.2%). Multiple linear regression analysis demonstrated the influence of age (ß=0.30, p=0.01) and serum creatinine (ß=0.15, p<0.0001) on the LVMI, independent of other factors, which confirms their independent pathogenetic significance. Conclusions: Patients with DM and CKD have structural and functional changes in the LV myocardium. Regardless of the nitrogen-excretion function of the kidneys, the predominant pattern of LV remodeling is concentric. The study of the features of structural and functional restructuring of the left heart in patients with diabetes should be taken into account in determining the cardiovascular prognosis.