Why the study?
Heart failure increases the risk of kidney disease progression, but whether cardiac function and structure are associated with incident chronic kidney disease is not well characterized in a community setting.
Are echocardiographic measures of cardiac structure and function associated with the risk of incident chronic kidney disease in older adults?
Are echocardiographic measures of cardiac structure and function associated with the risk of incident chronic kidney disease in older adults?
Abnormal echocardiographic measures of cardiac structure and function are independently associated with an increased risk of incident chronic kidney disease in older adults.
Echocardiographic abnormalities were associated with higher incident CKD risk; hypothesis-generating for cardio-renal risk prediction but should not yet change practice.
AIMS: Heart failure increases the risk of kidney disease progression. However, whether cardiac function and structure are associated with the risk of incident chronic kidney disease (CKD) is not well characterized in a community setting. METHODS AND RESULTS: Among 4188 participants (mean age 75 years and 22% blacks) of the Atherosclerosis Risk in Communities Study without prevalent CKD in 2011-13, we examined the association of echocardiographic measures of left ventricular (LV) mass index, ejection fraction, left atrial volume index (LAVi), right ventricular (RV) fractional area change, and peak RV-right atrium (RA) gradient, with the subsequent risk of incident CKD, as defined by >25% decline to estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, hospitalization with CKD diagnosis, or incident end-stage kidney disease. Multivariable Cox regression models were used to estimate hazard ratios (HRs). The risk of incident CKD was monotonically increased with each of higher LV mass index [adjusted HR 2.61 (1.92-3.55) for highest quartile (Q4) vs. lowest (Q1)], lower ejection fraction [1.54 (1.17-2.04) for Q1 vs. Q4], higher LAVi [2.12 (1.56-2.89) for Q4 vs. Q1], and higher peak RV-RA gradient [2.17 (1.45-3.25) for Q4 vs. Q1] but not with RV function. The associations were consistent between subgroups by sex and race. CONCLUSION: Among community-dwelling older individuals, LV mass index, ejection fraction, LAVi, and peak RV-RA gradient were independently associated with the risk of incident CKD. Our results further support that heart disease is associated with the risk of kidney disease progression and suggest the value of echocardiography for assessing cardiac and kidney health in older populations.
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Ishigami et al. (2020) studied this question.
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