Abstract 19077: Correlation of Renal Insufficiency With Left Ventricular Diastolic Dysfunction: How Medications Impact This Association?
Background: Increasing evidence between the association of chronic kidney disease (CKD) and left ventricular diastolic dysfunction (LVDD) has been emerging, however the impact of medications on this association has not been well studied.
Methods: In a cross-sectional study, we reviewed the medical records of patients who presented to the echocardiographic lab in a tertiary care academic center between 2008 and 2011. CKD staging was categorized based on the estimated glomerular filtration rate (eGFR). Diastolic function was evaluated based on echocardiographic characteristics. Using logistic regression analysis, the association between CKD severity and LVDD was examined after adjusting for potential demographic and clinical confounders. Then, we hypothesized that medications (i.e. angiotensin converting enzyme inhibitors [ACE-inh]/ Angiotensin II receptor blockers [ARB], statins, beta blockers, or any combination of these) might modify this association and examined the interaction term of medications in regards to the association between CKD severity (eGFR) and LVDD.
Results: Among 2443 patients, 1018 (41.7%) had normal eGFR, 757 (31%) had stage II, 443 (18.1%) stage III, 106 (4.3%) stage IV, and 119 (4.9%) stage V. LVDD was found in 1697 patients. Our data suggested that patients with CKD stage V have higher likelihood of developing LVDD (OR: 2.63, 95%CI 1.48-4.67, p=0.0006). Besides, higher CKD stage was associated with more severe LVDD (6.5%, 12.3%, 13.8%, 17.0%, and 20.2% patients with CKD stage I, II, III, IV, and V had LVDD stages II or higher, respectively).
The analysis of potential effect modifier indicated a significant interaction between CKD staging and treatment with statins, in regard to its association with LVDD (p=0.0008). Therefore, we categorized the patients based on the medications. The stratified analyses indicated that patients on Statins had weaker association between CKD stage V and LVDD (OR of 0.77 vs. 6.85).
Conclusions: Higher CKD stage is associated with presence and severity of LVDD. Statins can play a protective role, particularly in the higher stages of CKD.
- © 2013 by American Heart Association, Inc.