Abstract 15938: E/Em and Plasma BNP Predict Adverse Cardiovascular Outcome in Predialysis Chronic Kidney Disease: A Prospective Cohort Study
Background Preexisting cardiovascular disease (CVD) is a recognized predictor of future cardiovascular events (CVE) in pts with chronic kidney disease (CKD). There are little or no data on prognostication in predialysis CKD pts without overt CVD.
Methods We prospectively studied 142 pts with eGFR 15-60 ml and no clinically evident CVD by history, physical examination and echocardiography, i.e. normal LV ejection fraction (>50%) and regional wall motion. Plasma B-type natriuretic peptide (BNP), high-sensitivity C-reactive protein and carotid intima-media thickness (cIMT) were measured. Pts were followed for CVE, including death, heart failure hospitalization, acute coronary syndrome, cerebrovascular accident, critical limb ischemia and amputation. The effect of clinical, echocardiographic and laboratory variables on the development of a first CVE was evaluated via the competing risks methodology, taking into the account the development of end-stage renal disease (ESRD) requiring dialysis as a competing risk.
Results Mean pt age was 63±11 years, 58% were males and 54% diabetics. Mean eGFR at recruitment was 38±14 ml/min/1.73 m2. After a median follow-up of 5.3 years, 38 (27%) pts had a first CVE; 10 developed ESRD before their CVE. Univariately, age, BMI, diabetes, LV mass index, left atrial volume index, the ratio of early diastolic mitral flow and annular velocities (E/Em), cIMT, eGFR at recruitment and BNP were significant predictors of a first CVE. In the multivariable analysis, stepwise subdistribution hazard modeling found eGFR (p=0.006), E/Em (p=0.007), LV mass index (p=0.007) and BMI (p=0.020) to be independently predictive. When echocardiographic variables were excluded from the analysis, independent predictors were BNP (p=0.002), BMI (p=0.013), diabetes (p=0.02) and eGFR (p=0.02).
Conclusions E/Em and BNP independently predict future CVE in pts with moderate CKD and no overt CVD at outset. These indexes of intracardiac filling pressure and/or volume overload may help identify a target population for more aggressive primary preventive therapies.
- © 2011 by American Heart Association, Inc.