Echocardiography Based Assessment of Cardiac Function in Patients With Renocardiac Syndrome


  • Nadia Shams
  • Muhammad Hussain Baloch
  • Furquana Niaz
  • Lubna Meraj
  • Mubarak Ali



Chronic Kidney disease, Estimated Glomerular filtration rate, Reno-cardiac Syndrome, KDOQI classification


Objectives: There is rising world-wide burden of chronic kidney disease (CKD) with high Cardio-vascular mortality. This
research aims to study echocardiography based cardiac function with respect to CKD stages.
Study Design and Setting: This cross-sectional study was conducted at RIHS Islamabad (Jan 2021–Jan 2022) after ethical
Methodology: Total 130 adult CKD cases were included by consecutive sampling. Acute kidney injury and diagnosed/treated
cases of cardiac disease were excluded. BMI and GFR was calculated. CKD staging done by KDOQI-classification. Cardiac
impairment categorized by ECG and Echocardiography. Data analyzed by SPSS V-22 with Chi-square test.
Results: Amongst 130 CKD cases, there were 66(51%) males and 64(49%) females. Mean age was 60+13.27 years, mean
BMI was 24+4.2. Diabetes mellitus was observed in 100(76.9%), hypertension in 122(93.8%). Mean creatinine was
4.83mg/dl and mean GFR was 17.84 mL/min/1.73m2. Twenty-five(19.2%) patients were on hemodialysis. Mean cardiac
EF was 49.18%. EF was normal in 39(30%), mildly reduced in 40(30.8%), moderately reduced in 29(22.3%) and severely
reduced in 22(16.9%), diastolic dysfunction seen in 08(6.2%). Twenty-five(18.5%) cases had congestive cardiac failure;
14(56%) compensated and 11(44%) decompensated CCF. There was significant association between GFR and EF (p<0.0001).
Conclusions: Decline in cardiac function is associated with advanced CKD stages. Cardiac evaluation suggested at initial
presentation of CKD, hence diagnosing asymptomatic compensated heart failure. Study finds high burden of diabetes,
hypertension, anemia and IHD in CKD cases. GFR should be used rather than isolated creatinine in CKD. High clinical
suspicion and early intervention may lead to better outcome


Definition and classification of CKD, Kidney int suppl

;3:19. // www.kdigorg / Clinical –practice guideline /

pdf / CKD/ KDIGO -2012-CKD –GL.pdf.

Nayor M, Larson MG, Wang N, Santhanakrishnan R, Lee DS,

Tsao CW, Cheng S, et al. The association of chronic kidney

disease and microalbuminuria with heart failure with preserved

vs. reduced ejection fraction. Eur J Heart Fail, 2017;19: 615-


Jha V, Garcia G, Iseki K et al. Chronic kidney disease: global

Dimensions perspectives. The Lancet. 2013; 382 (9888): 260-


Jessani S, Bux R, Jafar TH. Prevalence, determinants, and

management of chronic kidney disease in Karachi, Pakistan

- a community based cross-sectional study. BMC Nephrol.

;15:90. DOI:

Jafar TH, Schmid CH, Levey AS. Serum creatinine as marker

of kidney function in South Asians: a study of reduced GFR

in adults in Pakistan. J Am Soc Nephrol. 2005;16(5):1413-


Nayak-Rao S, Shenoy MP. Stroke in Patients with Chronic

Kidney Disease. How do we Approach and Manage it? Indian

J Nephrol. 2017;27(3):167-171. DOI: 10.4103/


Ronco C, Haapio M, House AA, Anavekar N, Bellomo R.

Cardiorenal syndrome. J Am Coll Cardiol. 2008; 52(19):1527-


Hawwa N, Schreiber MJ Jr, Tang WH. Pharmacologic

management of chronic reno-cardiac syndrome. Curr Heart

Fail Rep. 2013;10(1):54-62. DOI: 10.1007/


Steenkamp R, Shaw C, Feest T. UK Renal Registry 15th

annual report: Chapter 5 survival and causes of death of UK

adult patients on renal replacement therapy in 2011: national

and centre-specific analyses. Nephron Clin Pract. 2013;123

Suppl 1:93-123. DOI:

Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL,

Hendriksen S. Using standardized serum creatinine values in

the modification of diet in renal disease study equation for

estimating glomerular filtration rate. Ann Intern Med.

;145(4):247-54. DOI:


Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL,

Carrero JJ, Chan W. KDOQI Clinical Practice Guideline for

Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020;76(3

Suppl 1):S1-S107. DOI: /j.ajkd.2020


Centers for Disease Control and Prevention. Chronic Kidney

Disease in the United States, 2021. Atlanta, GA: US

Department of Health and Human Services, Centers for

Disease Control and Prevention; 2021.

Iorember FM. Malnutrition in Chronic Kidney Disease. Front

Pediatr. 2018; 6: 161. DOI: 10.3389/ fped.


Ikizler TA, Cuppari L. The 2020 updated KDOQI clinical

practice guidelines for nutrition in chronic kidney disease.

Blood Purification. 2021;50(4-5):667-71. DOI:


Fliser D, Wanner C. Precision medicine in diabetic nephropathy

and chronic kidney disease. Nephrology Dialysis

Transplantation. 2021;36(Supplement_2):10-3. DOI:

Pugh D, Gallacher PJ, Dhaun N. Management of Hypertension

in Chronic Kidney Disease. Drugs. 2019;79(4):365-379. DOI:

Drüeke TB, Parfrey PS. Summary of the KDIGO guideline

on anemia and comment: reading between the (guide)line(s).

Kidney Int. 2012;82(9):952-60. DOI:


Levey AS, Inker LA. GFR as the “gold standard”: estimated,

measured, and true. American Journal of Kidney Diseases.

;67(1):9-12. DOI: j.ajkd.2015.


Jameel FA, Junejo AM, Khan QUA, Date S, Faraz A, Rizvi

SHM, et al. Echocardiographic Changes in Chronic Kidney

Disease Patients on Maintenance Hemodialysis. Cureus. 2020;

(7): e8969.

Mavrakanas TA, Khattak A, Wang W, Singh K, Charytan DM.

Association of Chronic Kidney Disease with Preserved Ejection

Fraction Heart Failure Is Independent of Baseline Cardiac

Function. Kidney Blood Press Res. 2019;44(5):1247-58.




How to Cite

Shams, N. ., Baloch, M. H. ., Niaz, F. ., Meraj, L. ., & Ali, M. . (2022). Echocardiography Based Assessment of Cardiac Function in Patients With Renocardiac Syndrome. Journal of Bahria University Medical and Dental College, 12(03), 143–147.



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