2.1.2. Interstitial Fibrosis

Di ffuse interstitial cardiac fibrosis is reported in uremic patients and progresses with advancing of CKD [11,13,20–22]. Recently, it was nicely reported that in early-stage CKD patients, noninvasive imaging biomarkers of myocardial fibrosis do not change if renal function remains stable [22]. Fibrosis alters the architecture of myocardium promoting the progression of cardiac disease (progressive impairment in contractility, systolic and diastolic dysfunction, dilated cardiomyopathy, congestive heart failure) towards heart failure (HF) and increase the risk for sustained atrial and ventricular arrhythmias [9]. This may explain why CKD patients are at increased risk of sudden cardiac death (SCD) [23]. Recent studies have pointed out that not only CKD-MBD well-known biomarkers like phosphate, vit D, and PTH [3,5,7] but also novel and early ones like FGF23 are involved in the regulation, growth, and di fferentiation of cardiac myocytes being players in the pathogenesis of LVH [3,5,11,12].
