Sex differences in cardiac function and remodelling in patients with preserved left ventricular ejection fraction across all stages of chronic kidney disease

OBJECTIVES: Chronic kidney disease (CKD) is associated with increased cardiovascular mortality. Sex-specific trajectories of multiple cardiac diseases, such as heart failure with preserved ejection fraction (HFpEF), have been identified. We aimed to identify differences in cardiac remodeling and function between females and males across all stages of CKD. METHODS: In this IRB-approved study, we retrospectively included 84 consecutive sex-matched patients with CKD stages 1-5 and a healthy sex-matched control group from the LGECKD study (n = 28). All patients underwent comprehensive cardiac MRI (CMR). Group comparisons were made using MANCOVA with adjustments for confounders Uni- and multivariate logistic regression was used to assess correlations between CMR parameters and left ventricular diastolic dysfunction (LV-DD) and incidence of major adverse cardiac events (MACE). RESULTS: Functional and strain parameters progressively declined with CKD stage in both sexes. Measures of left ventricular (LV) remodeling increased as CKD worsened in both sexes, with a loss of measurable differences in Groups 2 and 3 between sexes. Only in women CKD stage was associated with the presence of LV-DD while eGFR was associated with MACE in men. CONCLUSIONS: Sex differences in cardiac function and geometry disappear in late stages of CKD. This highlights the need for CKD-stage- and sex-specific thresholds while monitoring cardiac involvement in early stages of CKD. ADVANCES IN KNOWLEDGE: This study highlights distinct sex-specific trajectories in cardiac remodeling in patients with CKD and might help to identify divergent prognostic CMR parameters for adverse outcomes in female and male CKD patients.