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Small changes in kidney function may lead to heart, blood vessel damage
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Reduced renal function, even just slightly below normal, may increase left ventricular mass, according to study results published in Hypertension.
CRIB–Donor, a prospective, multicenter, parallel group, masked study, compared 68 living kidney donors with 56 healthy controls to investigate the association between reduction in renal function and adverse CV outcomes. The median age for donors was 47 years (44 years for controls). The primary outcome was a change in LV mass between baseline and 12 months. For donors, this was the first year after nephrectomy.
At 12 months, the researchers measured a decrease in isotopic glomerular filtration rate (–30 12 mL/min/1.73 m2) and an increase in LV mass (7 10 g vs. –3 8 g; P < .001) and mass-to-volume ratio (0.060.12 g/mL vs. –0.01 0.09 g/mL; P < .01) in donors compared with the controls. Results also showed that aortic distensibility decreased in donors (P = .03).
Compared with controls, donors also were at a higher risk for detectable highly sensitive troponin T (OR = 16.2; 95% CI, 2.6-100.01) and microalbuminuria (OR = 3.74; 95% CI, 1.09-12.75). Although there were no changes in ambulatory BP, the researchers observed increases in serum uric acid (P < .001), parathyroid hormone (P = .03), fibroblast growth factor-23 (P = .046) and high-sensitivity C-reactive protein (P < .01).
“Even in very healthy people, a small reduction in kidney function from normal to just a bit below normal was associated with an increase in the mass of the left ventricle, a change that makes the heart stiffer and impairs its ability to contract,” Jonathan Townend, MD, senior author of the paper and professor of cardiology at the Queen Elizabeth Hospital Birmingham, United Kingdom, said in a press release.
“This is evidence that reduction in kidney function itself leads directly to measurable adverse effects on the heart and blood vessels, even without other risk factors. More research is needed to know just what aspects of reduced kidney function are responsible for the effects,” he said.
According to Townend and colleagues, their findings suggest that reduced glomerular filtration rate should be considered a CV risk factor and that anyone with reduced kidney function should discuss how to lower their risk with their physician.
The researchers also emphasized, however, that kidney donors should not be concerned. “Kidney donors are already highly selected as healthy individuals. Our paper has shown that kidney donation causes very small adverse effects on the heart and blood vessels that took careful and accurate measurement to detect. We do not yet know if these effects are maintained over the long term. Even if there is a small increase in your long-term risk of heart disease after donation, it is still likely that you will be at lower than average risk,” Townend said. – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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