Left ventricular diastolic dysfunction in chronic kidney disease and anaesthesiaimplications

Aug 26, 2026

Left ventricular diastolic dysfunction is commonly observed in patients with chronic kidney disease, with echocardiography used to assess its presence and severity. The abnormality affects ventricular distensibility, filling and relaxation, while left ventricular ejection fraction may remain normal or decrease. In heart failure with preserved ejection fraction, symptomatic pulmonary congestion occurs despite systolic ejection fraction over 50%, often linked to diastolic dysfunction. Grade III diastolic dysfunction in surgical patients is associated with adverse cardiovascular events and perioperative haemodynamic instability and fluid overload, potentially leading to pulmonary oedema.

LanguageEnglish

CategoryHealthcare

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Pages10

Reading Time25 min

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Abstract

INTRODUCTION

Pathophysiology and assessment

111297_Auto_Edited.docx | WORD COUNT | 1996 | TIME SUBMITTED | 16-OCT-202502:25PM | | --- | --- | --- | --- | | | | PAPER ID | 118620902 | Name of Journal:World Journal of Nephrology Manuscript NO:111297 Manuscript Type:MINIREVIEWS # Left ventricular diastolic dysfunction in chronic kidney disease and anaesthesiaimplications Hemlata Kapoor,Dheeraj Kapoor ## Abstract Left ventricular diastolic dysfunction is frequently noticed in patients with chronickidney disease.Echocardiography is used to determine the presence and severity ofdiastolic dysfunction.In left ventricular diastolic dysfunction the ventricular diastolicdistensibility,filling or relaxation is abnormal;however,the left ventricular ejectionfraction may be normal or decreased.In heart failure with preserved ejection fraction,the patients have symptomatic pulmonary congestion even though the systolic ejectionfraction is more than 50%.This condition is commonly associated with ventriculardiastolic dysfunction.Increased incidence of major adverse cardiovascular events hasbeen reported in surgical patients having grade Ⅲ diastolic dysfunction.Peri-operatively haemodynamic instability and fluid overload in this set of patients isknown to generate pulmonary oedema. ## INTRODUCTION Patients with chronic kidney disease(CKD)often have cardiovascular disease whichaccounts for approximately 40%of the deaths in patients with CKD stage 4 and 5.[1]Long standing hypertension,chronic fluid overload and uraemia in these patients leadto diffuse interstitial myocardial fibrosis,abnormal myocardial relaxation and myocytedeath.[2,3]This reduction in left ventricular compliance leads to higher left ventricular filling pressures during diastole causing left ventricular diastolic dysfunction (LVDD).Diastolic dysfunction is considered the underlying pathophysiology for heart failurewith preserved ejection fraction.[4]Diastolic dysfunction is sensitive to impairedperfusion and hence is also an indicator of ischaemia in early stages.[5]In the initialstages,diastolic dysfunction is compensated by increased left atrial pressures.Asdiastolic dysfunction increases the symptoms of exertional dyspnoea and exerciseintolerance appear which can be confused with chronic obstructive pulmonary disease.This subset of patients sometimes develop haemodynamic instability and pulmonaryoedema postoperatively. ## Pathophysiology and assessment Ventricular diastole consists of four stages: Isovolumetric relaxation Passive ventricular filling Diastasis Atrial contraction Anatomically the duration of diastole is from closing of aortic valve to closure ofmitral valve.However,at the molecular level it starts during systole when the actin-myosin cross bridges start dissociating.[5]In diastolic dysfunction there is an increase inactivity of phospholamban and reduction in activity of sarcoplasmic/endoplasmicreticulum calcium ATPase 2(SERCA2)at cellular level.This leads to decrease incoupling of beta receptors with intracellular adenylate activity,thereby diminishing theresponse of heart to endogenous and exogenous catecholamines. Diastolic dysfunction can be ascertained by Doppler or cardiac catheterization.(Table 1)Cardiac catheterization is an invasive method to measure left ventricular pressures.The parameters measured by this technique are pressure/volume curves,the rate of leftventricular pressure decline,time constant of isovolumetric relaxation(t),leftventricular minimal pressure after opening of mitral valve and left ventricular pressurejust before atrial contraction. Left ventricular pressure/volume relation describes the systolic and diastolicfunction of ventricle and is represented as pressure/volume loops graphically.Insystolic dysfunction the end-systolic slope shifts downwards and rightwards.Indiastolic dysfunction the left ventricular end diastolic pressure and t is significantlyincreased and the diastolic curve shifts towards left and upwards.[6,7]In pa

FAQs

How is left ventricular diastolic dysfunction assessed in chronic kidney disease?

Echocardiography is used to determine whether diastolic dysfunction is present and to gauge its severity. Doppler methods are emphasized, and cardiac catheterization can measure left ventricular pressures directly.

What happens to filling and relaxation in left ventricular diastolic dysfunction?

Ventricular diastolic distensibility, filling or relaxation becomes abnormal. Left ventricular ejection fraction may be normal or decreased, depending on the patient and condition.

Why can pulmonary oedema occur perioperatively in patients with severe diastolic dysfunction?

In patients with advanced (grade III) diastolic dysfunction, perioperative haemodynamic instability and fluid overload can develop. These factors are known to generate pulmonary oedema.

Aug 26, 2026

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