Key result
Eccentric hypertrophy significantly increased the risk of composite renal events (HR 1.498) compared to normal left ventricular geometry in patients with pre-dialysis chronic kidney disease.
Why the study?
The impact of left ventricular geometry on renal outcomes in patients with chronic kidney disease had not yet been established.
Does abnormal left ventricular geometry predict composite renal events and all-cause mortality in patients with pre-dialysis chronic kidney disease?
Cohort (n=2,144)
Yes
Does abnormal left ventricular geometry predict composite renal events and all-cause mortality in patients with pre-dialysis chronic kidney disease?
Effect estimate: HR 1.498 (95% CI 1.197-1.873)
Absolute Event Rate: 48.9% vs 31%
p-value: p=<0.001
In patients with pre-dialysis chronic kidney disease, echocardiographic determination of left ventricular geometry identifies those at high risk for renal disease progression and all-cause mortality.
May aid renal risk stratification via LV geometry in pre-dialysis CKD; hypothesis-generating and requires prospective validation before practice change.
Background: The impact of left ventricular (LV) geometry on the renal outcomes in patients with chronic kidney disease (CKD) has not been established yet. We aimed to investigate the association of LV geometry with renal outcomes and all-cause mortality in patients with pre-dialysis CKD. Methods: A total of 2,144 subjects from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) were categorized by LV geometry, which was defined by LV mass index and relative wall thickness [normal geometry, concentric remodeling, eccentric hypertrophy (eLVH), and concentric hypertrophy (cLVH)]. Study outcomes were composite renal events [decline of kidney function (the first occurrence of > 50% decline of eGFR or doubling of serum creatinine from the baseline) and onset of ESRD (initiation of dialysis or kidney transplantation) during follow-up periods)] and all-cause mortality. Results: Cox regression analysis revealed that eLVH [adjusted hazard ratio (HR) 1.498, 95% confidence interval (CI) 1.197-1.873] and cLVH (adjusted HR 1.289, 95% CI 1.011-1.643) were associated with increased risk of composite renal events, whereas concentric remodeling (adjusted HR 1.881, 95% CI 1.135-3.118) and cLVH (adjusted HR 2.216, 95% CI 1.341-3.664) were associated with increased risk of all-cause mortality. Sensitivity analyses confirmed that concentric remodeling (adjusted HR 1.993, 95% CI 1.197-3.368) and eLVH (adjusted HR 1.588, 95% CI 1.261-2.001) are independently associated with all-cause mortality and composite renal events, respectively. Conclusion: In conclusion, we report that LV geometry is significantly associated with adverse renal outcomes and all-cause mortality in patients with pre-dialysis CKD. Echocardiographic determination of LV geometry may help the early identification for the patients with high risk of CKD progression.
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Suh et al. (2022) conducted a cohort in Pre-dialysis chronic kidney disease (n=2,144). Eccentric hypertrophy (eLVH) vs. Normal left ventricular geometry was evaluated on Composite renal events (>50% decline of eGFR, doubling of serum creatinine, or onset of ESRD) (HR 1.498, 95% CI 1.197-1.873, p=<0.001). Eccentric hypertrophy significantly increased the risk of composite renal events (HR 1.498) compared to normal left ventricular geometry in patients with pre-dialysis chronic kidney disease.
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