Associations between Kidney Function and Subclinical Cardiac Abnormalities in CKD

Park, Meyeon; Hsu, Chi-yuan; Li, Yongmei; Mishra, Rakesh; Keane, Martin; Rosas, Sylvia E.; Dries, Daniel L.; Xie, Dawei; Chen, Jing; He, Jiang; Anderson, Amanda H.; Go, Alan S.; Shlipak, Michael G.

doi:10.1681/asn.2012020145

Cited by 275 publications

(237 citation statements)

References 38 publications

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“…The observed associations in our study could be explained by the higher prevalence of diastolic dysfunction and volume overload (resultant pulmonary congestion) in those patients with mild to moderate CKD (10). Although there were no correlations noted between other parameters, such as pulmonary vascular resistance, cardiac index, and 6-minute walk test, and kidney function, a mild correlation was observed with PCWP.…”

Section: Discussioncontrasting

confidence: 57%

“…The most common cause of PH is left heart disease, including left-sided systolic dysfunction caused by ischemic and other cardiomyopathies with resultant volume overload (8,9). An important and frequently underappreciated cause of PH is left-sided heart failure with a preserved ejection fraction (EF; with or without underlying diastolic dysfunction), and these conditions are often noted in CKD (10,11). In patients with PH, elevated mean right atrial pressure (RAP), decreased cardiac index, and elevated mean PAP (mPAP) were associated with a poor prognosis (3,12).…”

Section: Introductionmentioning

confidence: 99%

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Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Navaneethan

Wehbe

Heresi³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Pulmonary hypertension is associated with higher mortality rates. The associations of nondialysis-dependent CKD and all-cause mortality in patients with pulmonary hypertension were studied.Design, setting, participants, & measurements The study population included those patients who underwent right heart catheterization for confirmation of pulmonary hypertension between 1996 and January 2011. Pulmonary hypertension was defined as the presence of mean pulmonary artery pressure$25 mmHg at rest measured by right heart catheterization. CKD was defined as the presence of two measurements of eGFR,60 ml/min per 1.73 m 2 90 days apart. The risk factors associated with CKD as well as the association between CKD and death in those patients with pulmonary hypertension using logistic regression and Cox proportional hazard models were examined.Results Of 1088 patients with pulmonary hypertension, 388 (36%) patients had CKD: 340 patients had stage 3 CKD, and 48 (4%) patients had stage 4 CKD. In the multivariable analysis, older age, higher hemoglobin, and higher mean right atrial pressures were independently associated with CKD. During a median follow-up of 3.2 years (interquartile range=1.5-5.6 years), 559 patients died. After adjusting for relevant covariates, presence of stage 3 CKD (hazard ratio, 1.37; 95% confidence interval, 1.14 to 1.66) and stage 4 CKD (hazard ratio, 2.69; 95% confidence interval, 1.88 to 3.86) was associated with all-cause mortality in those patients with pulmonary hypertension. When eGFR was examined as a continuous measure, a 5 ml/min per 1.73 m 2 lower eGFR was associated with a 5% (95% confidence interval, 1.03 to 1.07) higher hazard for death. This higher risk with CKD was similar irrespective of demographics, left ventricular function, and pulmonary capillary wedge pressure. ConclusionIn a clinical population referred for right heart catheterization, presence of CKD was associated with higher all-cause mortality in those patients with pulmonary hypertension. Mechanisms that may underlie these associations warrant additional studies.

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Section: Discussioncontrasting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Navaneethan

Wehbe

Heresi³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…48 Cardiac structure and function were assessed as previously described. 49,50 In brief, assessments were performed using two-dimensional images and a standard imaging protocol according to American Society of Echocardiography guidelines 51 and quantified centrally by a highly trained Registered Diagnostic Cardiac Sonographer.…”

Section: Covariatesmentioning

confidence: 99%

High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Risk of Incident Heart Failure in Patients with CKD

Bansal

Anderson

Yang

et al. 2015

Journal of the American Society of Nephrology

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111

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High-sensitivity troponin T (hsTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) strongly predict heart failure (HF) in the general population. However, the interpretation of levels of these biomarkers as predictors of HF is uncertain among patients with CKD. Here, we investigated whether hsTnT and NTproBNP are associated with incident HF among patients with CKD. In a prospective cohort analysis, we studied 3483 people with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study recruited from June of 2003 to August of 2008 who were free of HF at baseline. We used Cox regression to examine the association of baseline levels of hsTnT and NT-proBNP with incident HF after adjustment for demographic factors, traditional cardiovascular risk factors, markers of kidney disease, pertinent medication use, and mineral metabolism markers. At baseline, hsTnT levels ranged from #5.0 to 378.7 pg/ml, and NT-proBNP levels ranged from #5 to 35,000 pg/ml. Compared with those who had undetectable hsTnT, participants in the highest quartile (.26.5 ng/ml) had a significantly higher rate of HF (hazard ratio, 4.77; 95% confidence interval, 2.49 to 9.14). Similarly, compared with those in the lowest NT-proBNP quintile (,47.6 ng/ml), participants in the highest quintile (.433.0 ng/ml) experienced a substantially higher rate of HF (hazard ratio, 9.57; 95% confidence interval, 4.40 to 20.83). In conclusion, hsTnT and NT-proBNP were strongly associated with incident HF among a diverse cohort of individuals with mild to severe CKD. Elevations in these biomarkers may indicate subclinical changes in volume and myocardial stress that subsequently contribute to clinical HF.

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“…In contrast, reduced kidney function assessed by cystatin C was associated with a higher prevalence of LVH in the recent report from the Chronic Renal Insufficiency Cohort Study in adults. 17 …”

Section: Prevalence Of Lvhmentioning

confidence: 99%

BP Control and Left Ventricular Hypertrophy Regression in Children with CKD

Kupferman

Friedman

Cox

et al. 2014

Journal of the American Society of Nephrology

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In adult patients with CKD, hypertension is linked to the development of left ventricular hypertrophy, but whether this association exists in children with CKD has not been determined conclusively. To assess the relationship between BP and left ventricular hypertrophy, we prospectively analyzed data from the Chronic Kidney Disease in Children cohort. In total, 478 subjects were enrolled, and 435, 321, and 142 subjects remained enrolled at years 1, 3, and 5, respectively. Echocardiograms were obtained 1 year after study entry and then every 2 years; BP was measured annually. A linear mixed model was used to assess the effect of BP on left ventricular mass index, which was measured at three different visits, and a mixed logistic model was used to assess left ventricular hypertrophy. These models were part of a joint longitudinal and survival model to adjust for informative dropout. Predictors of left ventricular mass index included systolic BP, anemia, and use of antihypertensive medications other than angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Predictors of left ventricular hypertrophy included systolic BP, female sex, anemia, and use of other antihypertensive medications. Over 4 years, the adjusted prevalence of left ventricular hypertrophy decreased from 15.3% to 12.6% in a systolic BP model and from 15.1% to 12.6% in a diastolic BP model. These results indicate that a decline in BP may predict a decline in left ventricular hypertrophy in children with CKD and suggest additional factors that warrant additional investigation as predictors of left ventricular hypertrophy in these patients.

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Associations between Kidney Function and Subclinical Cardiac Abnormalities in CKD

Cited by 275 publications

References 38 publications

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

Presence and Outcomes of Kidney Disease in Patients with Pulmonary Hypertension

High-Sensitivity Troponin T and N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) and Risk of Incident Heart Failure in Patients with CKD

BP Control and Left Ventricular Hypertrophy Regression in Children with CKD

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