Chronic kidney disease-associated cardiomyopathy: clinical features, pathophysiology and treatment

Uraemic cardiomyopathy is a term widely used to describe the severe myocardial disease characterized by left ventricular hypertrophy and diffuse interstitial fibrosis that occurs in kidney failure. The causative factors are multiple and include many of the haemodynamic and metabolic abnormalities that are present in patients with chronic kidney disease (CKD). These abnormalities start to cause left ventricular damage and dysfunction in the early stages of CKD, probably from an estimated glomerular filtration rate of approximately 60 ml/min/1.73 m². The term ‘uraemic cardiomyopathy’ is therefore misleading and inaccurate, and we suggest instead using the term ‘CKD-associated cardiomyopathy’. In this Review, we describe the clinical manifestations and myocardial abnormalities seen on imaging in both CKD and kidney failure, discuss the multiple and interacting causative factors, and consider both established and prospective treatment options. A better understanding of the pathogenesis of CKD-associated cardiomyopathy is likely to lead to the introduction of effective preventive therapies, with success measured as a reduction in the proportion of patients reaching kidney failure with severe cardiomyopathy and ultimately in a reduction in the mortality from this condition.