Left Ventricular Mass is Associated with Biopsy-Assessed Renal Fibrosis in Chronic Kidney Disease

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BACKGROUND: Left ventricular remodeling predicts cardiovascular mortality in chronic kidney disease (CKD). Prior studies have linked renal functional markers to cardiac structural changes, but the direct relationship between cardiac MRI parameters and renal interstitial fibrosis remains uncharacterized. We aimed to investigate the association between cardiac remodeling and biopsy-assessed renal interstitial fibrosis in patients with CKD. MATERIALS & METHODS: This prospective single-center cohort included CKD patients with native kidneys who underwent same-week cardiac MRI and renal biopsy. Renal interstitial fibrosis was quantified as a percentage of the affected cortex area. Five cardiac parameters were selected: LVMi, LVEDVi, GLS, GCS, and myocardial T1. Associations with renal fibrosis were assessed using Spearman correlations, and multivariable linear regression adjusted for age and estimated glomerular filtration rate (eGFR). Sensitivity analyses were performed after excluding outliers. RESULTS: Forty-seven patients were included (median age, 49 years; 55% male). LVMi correlated with renal fibrosis (ρ = 0.49; p < 0.001). GLS (ρ = 0.33; p = 0.03) and GCS (ρ = 0.30; p = 0.04) showed consistent trends that did not survive statistical correction. Renal fibrosis remained associated with LVMi after adjustment for age and eGFR (β = 0.33; p < 0.001). Adding LVEDVi attenuated the fibrosis coefficient by 22% (β = 0.26; p < 0.001). The renal fibrosis - left ventricular mass association persisted after excluding patients with high LVMi or high fibrosis grades (ρ = 0.45, p = 0.002; ρ = 0.35, p = 0.026, respectively). CONCLUSION: In CKD patients, LV mass was associated with biopsy-assessed renal fibrosis, independently of eGFR, suggesting that structural renal injury provides information beyond kidney function alone. This association was only partially attenuated after adjustment for LV volume, indicating that volume-related hemodynamic factors may not fully account for the link between renal fibrosis and LV remodeling.

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