Abstract 18544: The Association of Kidney Disease Measures With Left-Sided Cardiac Structure and Function: The Atherosclerosis Risk in Communities (ARIC) Study
Introduction: Small studies with selected population such as hypertensives or diabetics reported the association of kidney disease with cardiac structure and function. A more comprehensive examination for glomerular filtration rate (GFR) and albuminuria regarding their relationships to cardiac structure and function in a large sample from the general population is needed.
Hypothesis: Both estimated GFR (eGFR) and albuminuria (urinary albuinu-cratinine ratio [ACR]) are associated with left-sided cardiac structure (left atrial volume index [LAVI], left ventricular end-diastolic diameter [LVEDD], and left ventricular mass index [LVMI]) and function (left ventricular ejection fraction [LVEF]).
Methods: We studied 4041 participants (mean age 75±5 years) of the ARIC Study who did not have prior coronary heart disease or heart failure at visit 5 (2011-13) and underwent transthoracic echocardiography. The association between the kidney measures and cardiac echo parameters was assessed using regression models incorporating spline terms of kidney measures (knots at their clinical cutpoints) with the adjustment for potential confounders.
Results: There were 1051 and 725 participants with reduced eGFR (<60 ml/min/1.73m2) and elevated ACR (≥30 mg/g), respectively. Reduced eGFR was associated with LAVI and LVMI only when it reached <30 ml/min/1,73m2 (Figure). In contrast, higher ACR was steadily associated with high LAVI, LVMI, and LVEDD and low LVEF (all P<0.001).
Conclusions: Elevated albuminuria was consistently associated with altered left-sided cardiac structure and function, whereas the alteration was restricted to some indices at moderate to severe stage for low eGFR. These findings suggest that kidney damage or its precedent conditions, e.g., endothelial dysfunction, are more involved in the pathophysiology of cardiac structural and functional alteration compared to kidney dysfunction.
- © 2013 by American Heart Association, Inc.