Screen CardRen: design and interim results of a cross-sectional cohort study to evaluate the prevalence of asymptomatic cardiac dysfunction in a high-risk population with chronic kidney disease

Chronic kidney disease (CKD) and cardiovascular (CV) disease share a large set of risk factors, such as arterial hypertension, diabetes mellitus and dyslipidaemia. CKD, even in early stages, further increases the risk for CV diseases such as heart failure (HF). 

Screen CardRen is a single-center, cross-sectional study with a target population of 400 adults with CKD stages G1-G4 and A1-A3 and at least one additional CV risk factor (arterial hypertension, type 2 diabetes mellitus, or dyslipidaemia). Exclusion criteria include a prior diagnosis of HF, end-stage renal disease, or recent acute CV events. Each participant undergoes a one-time visit involving clinical assessment, blood sampling, air displacement plethysmography, and echocardiography using both conventional and portable devices. The primary outcome is the prevalence of structural or functional cardiac abnormalities consistent with Stage B HF. Secondary objectives include the identification of diagnostic biomarkers and validation of hand-held ultrasound devices for screening. 

Until June 1st 2025, 125 patients have been enrolled. The median age is 72 (IQR 67.5, 78.0) years and 54% are female (table 1). The most frequent comorbidities are arterial hypertension (87%), dyslipidaemia (78%) and coronary artery disease (36%). The mean eGFR is 51.88 ml/min/1.73m² (SD 13.81) and the median UACR is 14.57 mg/g (IQR 8.81, 60.64), with the most prevalent CKD subgroups being G3a and A1. Despite the absence of a previous HF diagnosis, a significant proportion of patients show symptoms suggestive of HF as well as NT-proBNP levels >125 pg/ml (63%) and echocardiographic abnormalities (table 1), such as increases in left atrial volume index (LAVi) > 34ml/m² (23%) or left ventricular mass index (LVMi) >115/95 g/m² (m/f) (18%). The age and sex adjusted robust linear regression reveals a significant association between log-UACR and E/e’ (β 0.39, 95% CI 0.06-0.72, p=0.022, figure 3), while the relationships with other echocardiographic parameters remain inconclusive in this sample size. 

Early findings underscore the significant prevalence of subclinical cardiac dysfunction in patients with mostly moderate CKD and support the rationale for broader screening. Despite the limited sample size, associations between impaired renal function and echocardiographic signs of diastolic dysfunction were observed. Most participants exhibit preserved left ventricular (LV) ejection fraction and early signs of LV hypertrophy. Further research is needed to evaluate UACR as a potential risk indicator for the development of heart failure with preserved ejection fraction.