Cardiac structure, function linked with risk of kidney failure with replacement therapy
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Key takeaways:
- Interaction of heart disease with kidney disease may be present at subclinical stages.
- Echocardiographic parameters for left ventricular structure correlated with the risk of kidney disease.
Cardiac structure and function significantly correlated with risk of kidney failure with replacement therapy, according to data published in the American Journal of Kidney Diseases.
“Heart disease and kidney disease are known to interact with each other. This phenomenon is called cardiorenal syndrome. For example, we have previously reported that once heart failure is developed, it is associated with a high risk of subsequent kidney failure with replacement therapy,” Junichi Ishigami, MD, MPH, from Johns Hopkins Bloomberg School of Public Health, told Healio. “Because heart disease often progresses insidiously without clinical symptoms (we call this ‘subclinical heart disease’), we hypothesized that subclinical heart disease, as assessed in echocardiography, would be associated with an elevated risk of kidney disease progression among people living with chronic kidney disease.”
In a prospective observational cohort study, researchers examined 3,027 participants from the Chronic Renal Insufficiency Cohort Study to determine the relationship between cardiac function and structure with the risk of kidney failure with replacement therapy (KFRT) among patients with CKD.
With different aspects of cardiac structure and function serving as the exposures (left ventricular mass index (LVMI), LV volume, left atrial (LA) area, peak tricuspid regurgitation (TR) velocity, and left ventricular ejection fraction (EF) as assessed by echocardiography), researchers considered incident KFRT the primary outcome.
Using multivariable Cox models, researchers estimated the HRs with incident KFRT.
A total of 883 participants developed KFRT during the study period. Researchers identified a correlation between higher LVMI, LV volume, LA area, peak TR velocity and lower EF with an increased risk of KFRT. Additionally, participants in the highest vs. lowest quartiles (lowest vs. highest for EF) showed a statistically significantly faster decline in eGFR, except for the LA area.
“Echocardiography can assess different aspects of cardiac structure and function. In our study, echocardiographic parameters for left ventricular structure (eg, left ventricular hypertrophy) and right ventricular filling pressure (eg, pulmonary hypertension) were particularly strongly associated with the risk of kidney disease progression. Our findings suggest that these conditions play an important role in the progressive kidney disease associated with heart disease,” Ishigami and colleagues wrote. “Further, our study suggests that interaction of heart disease with kidney disease may exist even at its subclinical stages. Thus, when cardiac abnormalities are identified, it is important to properly monitor the risk of kidney disease progression and consider optimal treatment for protecting the heart and kidney health, such as the use of renin-angiotensin-system inhibitors and sodium-glucose co-transporter 2 inhibitors, when these medications are indicated.”
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