Albuminuria and kidney function as prognostic marker of left ventricular mass among South Asians with hypertension

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=539). Intervention: Baseline and longitudinal changes in urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) vs. Lower baseline UACR (<0.14 mg/g/y rate of UACR increase) and preserved eGFR. Primary outcome: Left ventricular mass index (LVMI) at 7 years (β = 2.26 (baseline log-UACR); β = 4.19 (UACR increase ≥1.07 vs <0.14 mg/g/y); β = -1.05 (rate of eGFR decline), 95% CI 0.87 to 3.65, p=0.002).

Q: What does this research mean for the field?

Higher baseline albuminuria, greater progression of albuminuria, and faster decline in eGFR are independently associated with higher 7-year left ventricular mass index and risk of left ventricular hypertrophy in hypertensive individuals. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the association of baseline albuminuria and estimated glomerular filtration rate (eGFR), along with their longitudinal changes, with left ventricular mass index (LVMI) at 7 years in hypertensive adults from Pakistan.

Liang Feng; Aamir Hameed Khan; Imtiaz Jehan; John Carson Allen; Tazeen H. Jafar

doi:10.1016/j.jash.2017.10.003

October 14, 2017Journal of the American Society of HypertensionOpen Access

Albuminuria and kidney function as prognostic marker of left ventricular mass among South Asians with hypertension

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Key result

Worsening kidney function and higher UACR are independently linked to increased 7-year LV mass index.

β = 2.26 (baseline log-UACR); β = 4.19 (UACR increase ≥1.07 vs <0.14 mg/g/y); β = -1.05 (rate of eGFR decline)
95% CI 0.87 to 3.65
P=0.002
n=539

Why the study?

Are baseline levels and longitudinal worsening of albuminuria (UACR) and kidney function (eGFR) associated with higher left ventricular mass index and left ventricular hypertrophy at 7 years in South Asian adults with hypertension?

Key Points

To evaluate the association of baseline albuminuria and estimated glomerular filtration rate (eGFR), along with their longitudinal changes, with left ventricular mass index (LVMI) at 7 years in hypertensive adults from Pakistan.
Analyzed a nested cohort of 539 hypertensive adults aged 40 years and older followed for 7 years in the Control of Blood Pressure and Risk Attenuation trial in Karachi, Pakistan.
Assessed urine spot albumin-to-creatinine ratio (UACR) and serum creatinine-based eGFR at baseline and 7 years, alongside echocardiography at 7 years.
Higher baseline UACR was significantly associated with higher follow-up LVMI (β = 2.26; 95% CI: [0.87, 3.65]), as was a rate of UACR increase ≥1.07 mg/g/y compared to <0.14 mg/g/y (β = 4.19; 95% CI: [0.75, 7.63]).
A greater rate of decline in eGFR was independently associated with higher LVMI (β = −1.05; 95% CI: [−1.94, −0.17]; P = .02 per 1 mL/min/1.73 m²/y decline).
Left ventricular hypertrophy was significantly associated with lower baseline eGFR (OR = 0.97; 95% CI: [0.95, 0.99]) and higher baseline UACR (OR = 1.37; 95% CI: [1.04, 1.80]), but not with the rate of eGFR decline.

Study Design

Type

Cohort (n=539)

Multicenter

No

Structured PICO

Are baseline levels and longitudinal worsening of albuminuria (UACR) and kidney function (eGFR) associated with higher left ventricular mass index and left ventricular hypertrophy at 7 years in South Asian adults with hypertension?

P

Population

539 community-dwelling adults aged ≥40 years with hypertension in Karachi, Pakistan (mean age 50.9 years, 63% female), followed for 7 years.

E

Exposure

Baseline and 7-year longitudinal changes in kidney biomarkers: spot urine albumin-to-creatinine ratio (UACR), rate of UACR increase (≥1.07 mg/g/y and 0.14-1.07 mg/g/y), serum creatinine-based estimated glomerular filtration rate (eGFR using CKD-EPI Pakistan equation), and rate of decline in eGFR over 7 years.

C

Comparator

Lower UACR / lower rate of UACR increase (<0.14 mg/g/y reference group) and higher / preserved eGFR.

O

Outcome

Left ventricular mass index (LVMI, in g/m²) at 7 years follow-up, measured by M-mode and 2D echocardiography.surrogate

Main Result

Mean Difference: 2.26 (95% CI 0.87–3.65)

p-value: p=0.002

Baseline screening and longitudinal monitoring of both eGFR and UACR independently predict 7-year left ventricular mass index and hypertrophy in South Asian adults with hypertension, supporting their utility for cardiovascular risk stratification in resource-constrained settings.

Limitations

Echocardiography was not performed at baseline, preventing evaluation of confounding by baseline LVMI and establishment of causality.
Only 40% of the original COBRA cohort had echocardiographic data available at the 7-year follow-up, representing a relatively healthier subset.
History of hypertension duration and legacy effect of uncontrolled blood pressure were not accounted for in the analysis.
Kidney biomarkers were only measured at baseline and end of follow-up, permitting examination of only linear changes over time.
M-mode and 2D echocardiographic LVMI measurements have operator-dependent technical limitations and assume a uniform geometric shape of the left ventricle.
Echocardiography was not performed at baseline, preventing evaluation of confounding by baseline LVMI and precluding a cause-effect conclusion.
Only 40% of the original COBRA cohort were available with echocardiographic data at 7-year follow-up, representing relatively healthier hypertensive individuals.
History of hypertension and legacy effect of uncontrolled blood pressure were not accounted for in the analysis.
Kidney biomarkers were measured only at baseline and end of follow-up, allowing assessment of only linear changes over time.
LVMI measurements using M-mode and 2D echocardiography have operator-dependent technical issues and rely on geometric assumptions of the left ventricle.

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Implication

Higher UACR and faster eGFR decline were associated with 7-year LVMI; hypothesis-generating for renal markers in LVH risk stratification and requires prospective validation.

Abstract

We aimed to evaluate the association of albuminuria and estimated glomerular filtration rate (eGFR) at baseline and changes in these parameters with left ventricular mass index (LVMI) at 7 years in adults with hypertension from communities in Pakistan. A nested cohort of 539 hypertensives aged 40 years and older from a community-living population in Karachi, Pakistan, followed up for 7 years in the Control of Blood Pressure and Risk Attenuation trial. Urine spot albumin-to-creatinine ratio (UACR) and serum creatinine-based eGFR were assessed at baseline and 7 years, and echocardiography at 7 years. Mean age of participants was 50.9 ± 9.1 (standard deviation) years; 63% were female. Mean eGFR was 91.0 ± 15.9 (standard deviation) mL/min/1.73 m 2 and median (interquartile range) UACR 6.2 (3.9, 11.3) mg/g. In multivariate analysis, although baseline eGFR was marginally associated with LVMI, a strong association was found between higher LVMI with greater rate of decline in eGFR (β = −1.05; 95% confidence interval [CI]: [−1.94, −0.17]). Higher baseline UACR was significantly associated with higher follow-up LVMI (β = 2.26; 95% CI: [0.87, 3.65]), as was rate of UACR increase of ≥1.07 mg/g/y versus of <0.14 mg/g/y. (β = 4.19; 95% CI: [0.75, 7.63]). Associations with developing left ventricular hypertrophy were found for reduced baseline eGFR, higher baseline UACR, and greater rate of UACR increase, but not for rate of eGFR decline. Comparable results were observed for the outcomes of posterior wall thickness and septal wall thickness. Higher baseline albuminuria, lower baseline eGFR, and their longitudinal worsening were significantly associated with higher LVMI or the development of left ventricular hypertrophy among individuals with hypertension in Pakistan.

Discussion

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Cite This Study

Feng et al. (2017) conducted a cohort in Hypertension (n=539). Baseline and longitudinal changes in urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) vs. Lower baseline UACR (<0.14 mg/g/y rate of UACR increase) and preserved eGFR was evaluated on Left ventricular mass index (LVMI) at 7 years (β = 2.26 (baseline log-UACR); β = 4.19 (UACR increase ≥1.07 vs <0.14 mg/g/y); β = -1.05 (rate of eGFR decline), 95% CI 0.87 to 3.65, p=0.002).

synapsesocial.com/papers/6a75e138756843cacbb234ee https://doi.org/10.1016/j.jash.2017.10.003

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Albuminuria and kidney function as prognostic marker of left ventricular mass among South Asians with hypertension

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Albuminuria and kidney function as prognostic marker of left ventricular mass among South Asians with hypertension

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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