Left atrial (LA) dysfunction contributes to adverse cardiovascular outcomes in end-stage kidney disease (ESKD), yet its trajectory and reversibility remain uncertain. A prospective observational study published in the Echocardiography evaluated LA structure and function in 111 patients with ESKD listed for renal transplantation and 45 healthy controls. 

All participants underwent two-dimensional echocardiography and treadmill exercise testing at baseline and at 6 months. Patients who did not undergo transplantation during follow-up continued maintenance hemodialysis, allowing comparative longitudinal assessment.

At baseline, LA volumes were significantly elevated in patients with ESKD irrespective of dialysis status. LA emptying fraction (LAEF) did not differ significantly between groups (p=0.073). However, patients receiving hemodialysis demonstrated a higher prevalence of elevated LA pressure (p<0.001) and lower LA function index (LAFI) compared with controls (p=0.001), with LAFI remaining reduced after multivariable adjustment. 

At 6 months, patients who underwent renal transplantation showed significantly higher LAEF and LAFI compared with those maintained on hemodialysis (adjusted Pint=0.013 and 0.045, respectively). Functional correlations were also observed, as both LAEF and LAFI were positively associated with exercise capacity at baseline. Additionally, longitudinal improvement in LAFI correlated with increased exercise duration during follow-up.

LA dysfunction was evident in ESKD, particularly among patients receiving dialysis. Renal transplantation was associated with improved LA function and exercise performance.