Work

Reversal of Uraemic Cardiomyopathy following Kidney Transplantation: Systematic Review and Meta-Analysis of Myocardial Strain Compared to Left Ventricular Volumetry as a Potential Early Marker

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: INTRODUCTION: Adverse cardiovascular changes associated with end-stage kidney disease (ESKD), referred to as uraemic cardiomyopathy, can potentially be reversed by kidney transplantation (KTx). Myocardial strain is hypothesized to be a more sensitive marker for reversal of uraemic cardiomyopathy following KTx than conventional left ventricle (LV) volumetric measurements. This meta-analysis study compared post-KTx changes in myocardial strain (global longitudinal strain [GLS], global circumferential strain [GCS], global radial strain [GRS]) and LV volumetry (left ventricular mass index [LVMi], left ventricular ejection fraction [LVEF], LV end-diastolic volume indexed [LVEDVi], and left ventricular end-systolic volume indexed [LVESVi]) measured by cardiac magnetic resonance (CMR) and echocardiography. METHODS: A systematic search was performed on PubMed for articles published through November 2025. Studies meeting the inclusion criteria, assessing paired myocardial strain pre- and post-KTx in adult ESKD patients using echocardiography or CMR, were included in the meta-analysis. RESULTS: Ten echocardiographic and three CMR studies were included, with follow-up durations ranging from 1 to 36 months. Strain measurements improved across all parameters, LV GLS (standardized mean difference [SMD] -1.57 [95% CI: -2.66, -0.48]; p = 0.005), LV GCS (SMD -1.63 [95% CI: -2.33, -0.93]; p < 0.00001) and LV GRS (SMD 3.34 [95% CI: 1.08, 5.59]; p = 0.004). Conventional LV volumetric measurements also improved, LVMi (SMD -17.93 [95% CI: -26.19, -9.68]; p < 0.0001), LVEF (SMD 5.45 [95% CI: 0.17, 10.72); p = 0.04), LVEDVi (SMD -12.72 [95% CI: -17.59, -7.84]; p < 0.00001), and LVESVi (SMD -8.79 [95% CI: -11.72, -5.86]; p < 0.00001). CONCLUSION: These findings indicate a reversal of uraemic cardiomyopathy following KTx. However, since both strain and volumetric measurements showed similar patterns of improvement across CMR and echocardiography, myocardial strain could not be confirmed as a more sensitive marker of uraemic cardiomyopathy reversal than LV volumetry.

Source: Kidney & Blood Pressure Research

DOI: 10.1159/000551664

Authors: Daniek van der Kaaij, Begawan A. Siadari, Aiko P. J. de Vries, Hildo J. Lamb, Ilona A. Dekkers

Institutions: Leiden University Medical Center, Amsterdam UMC Location University of Amsterdam, Amsterdam University Medical Centers

Language: English

Topic: Cardiovascular Function and Risk Factors

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,780