The Interrogation of the Cardiomyopathy of Chronic Kidney Disease With advancEd caRdiac Imaging

Background: Patients with chronic kidney disease (CKD) are at a dramatically increased risk of cardiovascular disease. This risk is greatest in patients on dialysis and is not explained by conventional cardiovascular risk factors. Myocardial fibrosis, so called Cardiomyopathy of CKD (CM-CKD), in conjunction with excessive arterial calcification, forms the pathological basis for this excess risk. Due to limitations of using myocardial biopsy, combined with the inability to use gadolinium-enhanced imaging in patients with advanced CKD, there is an urgent need for reliable non-invasive ways of diagnosing and investigating CM-CKD. Study participants: Adult patients established on regular hospital-based haemodialysis, with evidence of recurrent fluid overload requiring fluid removal by ultrafiltration on dialysis. Study design: This is a single centre observational study. We will perform cardiac MRI (CMR), contrast CT and blood tests in 30 patients before haemodialysis, with a repeat CMR and blood tests post-dialysis. Objectives: To assess: 1. If myocardial native T1 mapping on CMR is affected by fluid status and therefore test the validity of T1 mapping as a marker of fibrosis within the dialysis population? 2. If contrast-enhanced dynamic-equilibrium CT can refine insights into the myocardium in CM-CKD? 3. If novel CMR methods can effectively identify and delineate arterial calcification compared to CT? Relevance: This project will have immediate clinical relevance by clarifying key questions in the diagnosis and investigation of CM-CKD. It will also inform as to the potential role for these novel imaging biomarkers as surrogate end-points for use in future clinical trials exploring disease specific drug therapies.