REN and chronic kidney disease: LA dysfunction in patients with chronic kidney disease (CKD) isindependently regulated by renal function, and LA alterations may consequentlyincrease the activation of the renin‒angiotensin‒aldosterone pathway, causingmyocardial fibrosis in CKD and the development of atrial myopathy [13].Microvascular damage in patients with DN leads to inadequate myocardialperfusion, decreased atrial wall elasticity, diminished cardiac filling function,and a compensatory increased workload in the LA to maintain normal LV filling.