The bidirectional link between left ventricular hypertrophy and chronic kidney disease. A cross lagged analysis

BACKGROUND: Heart failure (HF) is known to reduce glomerular filtration rate (GFR), while chronic kidney disease (CKD) significantly increases the risk of left ventricular hypertrophy (LVH) and HF. Although these connections have been explored in separate studies, comprehensive research examining the mutual links between CKD and LVH progression is lacking. METHODS: Our study investigates the longitudinal relationship between estimated GFR (eGFR) and left ventricular mass index (LVMI) in a cohort of 106 CKD patients across stages G1-5. Using a cross-lagged model, we paired each predictor (eGFR or LVMI) with subsequent outcome measurements, adjusting for previous values to ensure accuracy. Over a three-year follow-up period, we analyzed 257 paired LVMI and eGFR measurements. RESULTS: At baseline, the median eGFR was 54 ml/min/1.73 m 2 , and the LVMI was 134 ± 48 g/m 2 , with a 62% prevalence of LVH. Our adjusted models revealed that a decrease in eGFR by 1 ml/min/1.73 m 2 predicted an increase in LVMI of 1.12 g/m 2 (95% CI: 0.71-1.54, P < 0.001). In contrast, high LVMI did not predict a reduction in eGFR over time. This analysis highlights a significant risk of LVH worsening due to GFR loss, while the reverse risk does not achieve statistical significance. CONCLUSIONS: Although these observational analyses cannot establish causality, they suggest that the risk of cardiomyopathy driven by kidney disease in stable CKD patients may be more substantial than the risk of CKD progression driven by heart disease. This insight underscores the importance of monitoring kidney function to manage cardiovascular risk in CKD patients.