Table 2.
Summary of Key Findings in Studies Using cMRI in Patients With ESKD
| Study | Study Type | Patient Characteristics | Imaging Parameter | Results | Limitations |
|---|---|---|---|---|---|
| Odudu et al44 (2016) | Cross sectional multicenter study | 54 HD patients and 29 age- and sex-matched controls | LVMI, systolic circumferential strain, EF | Reduced global systolic function by EF (51% ± 10% in HD vs 59% ± 5% in controls; P < 0.001) and peak systolic circumferential strain (15.9% ± 3.7% in HD vs 19.5% ± 3.3% in controls; P < 0.001); LVMI was increased in HD patients vs controls (63; 95% CI, 54-79 vs 46; 95% CI, 42-53 g/m2; P < 0.001) | Cross sectional design; small study population |
| Shamir et al45 (2018) | Cross-sectional multicenter study | 80 adult patients on maintenance HD stratified by average change in SBP during HD in 1-mo period | LVMI | Intradialytic HTN (SBP increase >10 mm Hg during dialysis) was associated with LVMI (12.5; 95% CI, 3.6-21.5 g/m2; P = 0.01) | Cross-sectional design; only 7 of 80 patients in cohort had intradialytic HTN |
| Stromp et al58 (2018) | Cross-sectional single center study | 33 patients on HD and 44 healthy controls | Myocardial fibrosis, LVMI | Novel magnetization-transfer weighted images used to quantitate myocardial fibrosis: increased myocardial fibrosis in ESKD patients than in controls (P < 0.001); LVMI increased in ESKD patients and correlated with severity of fibrosis (P = 0.014) | Imaging modality not previously validated; small sample size |
| Ross et al46 (2017) | Prospective 2-center cohort study | 67 maintenance HD patients | LVMI | Volume overload: intradialytic weight gain and ultrafiltrate volume correlated with LVEDV at baseline and 12 mo; intradialytic weight gain correlated longitudinally with LVEDV (r = −0.27; P = 0.043) Pressure overload: elevated SBP correlated to LVMI at baseline, 12 mo, and longitudinally (r = 0.64; P < 0.001) Cardiac remodeling: SBP correlated with ratio of LVM:LVEDV at baseline, 12 mo, and longitudinally (r = 0.37; P = 0.005) |
Small sample size; nongeneralizable cohort |
| Ong et al49 (2019) | Prospective 2-center cohort study | 67 Patients on conventional HD. 37 converted to INHD, 30 remained on conventional HD | GCS | Compared to baseline MRI, at 12 mo, INHD showed improvement in GCS compared to conventional HD (P = 0.025) | Not randomized; small sample size |
| Buchanan et al50 (2017) | Randomized prospective crossover pilot trial | 12 patients randomized 1:1 to either HD or HDF for 2 wk; subsequently crossed over to other kidney replacement modality | GCS and GLS | Significant reductions in intradialytic GLS and GCS from baseline regardless of kidney replacement modality | Small sample size |
| Rutherford et al55 (2017) | Prospective single-center cohort study | 22 maintenance HD patients on dialysis for <1 y | Myocardial fibrosis, LVMI | No significant change in myocardial fibrosis. septal native T1 time unchanged from baseline to 6 mo; LVMI significantly reduced at 6 mo (baseline: 78.3 g/m2; 6 mo, 67.9 g/m2; P < 0.0001) | Small sample size; single center |
Abbreviations: CI, confidence interval; cMRI, cardiac magnetis resonance imaging; EF, ejection fraction; ESKD, end-stage kidney disease; GCS, global circumferential strain; GLS, global longitudinal strain; HD, hemodialysis, HDF, hemodiafiltration; HTN, hypertension; INHD, in-center nocturnal hemodialysis; LVEDV, left ventricular end-diastolic volume; LVM, left ventriculat mass; LVMI, left ventricular mass index; MRI, magnetic resonance imaging; SBP, systolic blood pressure.