Right Ventricular Dysfunction Across Chronic Kidney Disease Stages: An Echocardiographic Cross-Sectional Study

Abstract

Background: Chronic kidney disease (CKD) is accompanied by a substantial cardiovascular burden, yet right ventricular (RV) involvement is less consistently characterized than left ventricular disease. The RV is particularly vulnerable to changes in preload, pulmonary vascular load, anemia, volume expansion, and hemodialysis-related hemodynamic stress. A stage-focused assessment may clarify whether conventional echocardiographic RV abnormalities track directly with declining kidney function or reflect a more complex cardiorenal-pulmonary interaction. Objective: To describe the prevalence and stage-wise distribution of RV systolic dysfunction in adults with CKD and to examine associations among estimated glomerular filtration rate (eGFR), tricuspid annular plane systolic excursion (TAPSE), right ventricular ejection fraction (RV-EF), pulmonary artery systolic pressure (PASP), and left ventricular ejection fraction (LV-EF).

Methods: This stage-focused secondary analysis used a cross-sectional observational cohort of 100 adults with CKD evaluated at the echocardiography clinic of Baquba Teaching Hospital, Diyala, Iraq, between August 2025 and February 2026. Clinical assessment, serum creatinine/urea testing, eGFR estimation, and transthoracic echocardiography were performed. RV systolic function was assessed using TAPSE and RV-EF; PASP was estimated from the tricuspid regurgitation jet. CKD stage and reported normal/abnormal RV categories were retained from the source study. Stage-wise proportions were recalculated from the reported aggregate counts, and chi-square tests were recomputed for the stage-by-RV-category tables. Results: The cohort included 100 participants; 53% were older than 60 years and 58% were receiving hemodialysis. CKD stage distribution was stage 2, 1%; stage 3, 18%; stage 4, 33%; and stage 5, 48%. Abnormal RV-EF was present in 51%, while abnormal TAPSE was present in 35%. The proportion with abnormal TAPSE was 0.0%, 44.4%, 42.4%, and 27.1% in stages 2–5, respectively (recomputed chi-square p=0.339). Abnormal RV-EF occurred in 0.0%, 50.0%, 45.5%, and 56.3% across stages 2–5 (p=0.576). Mean eGFR did not differ significantly between normal and abnormal TAPSE groups or between normal and abnormal RV-EF groups. In the reported correlation analysis, PASP correlated inversely with eGFR (r=-0.207, p=0.039) and TAPSE (r=-0.256, p=0.010), while LV-EF correlated positively with RV-EF (r=0.367, p<0.001). Conclusions: RV systolic abnormalities were common in this CKD cohort but did not show a simple monotonic relationship with CKD stage. The observed associations of PASP with both eGFR and TAPSE suggest that pulmonary vascular load and volume/hemodynamic factors may be clinically important links between renal impairment and RV performance. Comprehensive right-heart assessment may therefore provide information not captured by CKD stage alone. Larger prospective studies using standardized RV measurements and longitudinal outcomes are warranted.