Supplementary Material for: Reversal of uraemic cardiomyopathy following kidney transplantation: systematic review and meta-analysis of myocardial strain compared to left ventricular volumetry as a potential early marker

Introduction Adverse cardiovascular changes associated with end-stage kidney disease (ESKD), referred to as uraemic cardiomyopathy, can potentially be reversed by kidney transplantation (KTx). Myocardial strain is hypothesized to be a more sensitive marker for reversal of uraemic cardiomyopathy following KTx than conventional left ventricle (LV) volumetric measurements. This meta-analysis study compared post-KTx changes in myocardial strain (GLS, GCS, GRS) and left ventricular (LV) volumetry (LVMi, LVEF, LVEDVi, and LVESVi) measured by cardiac magnetic resonance (CMR) and echocardiography. Methods A systematic search was performed on PubMed for articles published through November 2025, and studies meeting the inclusion criteria—assessing paired myocardial strain pre- and post-KTx in adult ESKD patients using echocardiography or CMR—were included in the meta-analysis. Results Ten echocardiographic and three CMR studies were included, with follow-up durations ranging from 1 to 36 months. Strain measurements improved across all parameters, LV GLS [Standardized Mean Difference (SMD) -1.57 (95%CI -2.66, -0.48); p=0.0.005], LV GCS [SMD -1.63 (95%CI -2.33, -0.93); p<0.00001] and LV GRS [SMD 3.34 (95%CI 1.08, 5.59); p=0.004]. Conventional LV volumetric measurements also improved, LVMi [SMD -17.93 (95%CI -26.19, -9.68); p<0.0001], LVEF [SMD 5.45 (95%CI 0.17, 10.72); p=0.04], LVEDVi [SMD -12.72 (95%CI -17.59, -7.84); p<0.00001] and LVESVi [SMD -8.79 (95%CI -11.72, -5.86); p<0.0001. Conclusion These findings indicate a reversal of uraemic cardiomyopathy following KTx. However, since both strain and volumetric measurements showed similar patterns of improvement across CMR and echocardiography, myocardial strain could not be confirmed as a more sensitive marker of uraemic cardiomyopathy reversal than LV volumetry.