Remodeling of the left atrium in patients with 4-5 stage chronic kidney disease

Purpose of the study. To investigate clinical and functional aspects of the left atrial remodeling in patients with stage 4-5 of the chronic kidney disease (CKD). Materials and methods. A total of 172 patients with CKD stage 4-5 at aged 16-74 years, were examined. Depending on the anterior-posterior size of the left atrium (LA) in diastole, all examined individuals (n = 172) were divided into two groups: 1st - individuals with CKD and normal size (less than 4.0 cm) of the LA (n = 126), 2nd - patients with CKD and increased anterior-posterior size (more than 4.0 cm) of the LA (n = 46). General physical examination and transthoracic echocardiography with the definition of the LA index in diastole was performed. Results. Statistically significant increase in the end systolic (4.20 ± 0.65 cm vs. 3.55 ± 0.47 cm, p < 0.01) and diastolic dimensions (5.97 ± 0.55 cm vs. 5,38 ± 0,43 cm, p < 0.01), thickness of interventricular septum (1,17 ± 0,16 cm vs 0,99 ± 0,14 cm, p < 0.01) and left ventricular posterior wall (1,13 ± 0.15 cm vs 0.97 ± 0.13 cm, p < 0.01) compared to CKD patients with normal size (less than 4.0 cm) of LA. In patients with left atrial dilatation, significantly higher values of the indexed mass of left ventricular myocardium (267 ± 62 g/m2 vs 198 ± 44 g/m2, p < 0.01) were registered. Eccentric type of the heart structural restructuring was significantly more often detected in the 1st group (87.3% vs 56.5%, p < 0.01) in comparison with the 2nd group. Frequency of the concentric type of left ventricular hypertrophy was significantly higher in the group with left atrial dilatation (43.5% vs 12.7%, p < 0.01) in comparison with the 1st group. In patients with CKD, left atrial dilatation was associated with a significant increase in the anterior - posterior dimension of the right ventricle (2.24 ± 0.47 cm vs 1.83 ± 0.37 cm, p < 0.01) and thickness of its anterior wall (0.41 ± 0.03 cm vs 0.39 ± 0.03 cm, p < 0.01). Patients of the 2nd group had higher body mass index values (25.5 ± 5.14 kg m vs 23.6 ± 3.91 kg/m, p < 0.01), systolic (168 ± 29 mm Hg vs 152 ± 27 mm Hg, p< 0.01) and diastolic (102 ± 20 mm Hg vs 94 ± 15 mm Hg, p < 0.01) arterial pressure, C-reactive protein (84.7% vs 20.6%, p < 0.01). Conclusion. In patients with at predialysis stage of CKD, left atrial remodeling is accompanied by increased levels of C-reactive protein and forming of concentric type of left ventricular hypertrophy.