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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Echocardiographic measures and subsequent decline in kidney function in older adults: the Atherosclerosis Risk in

Junichi Ishigami1, Lena Mathews1,2, Manabu Hishida1

  • 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument St., Suite 2-600, Baltimore, MD 21287, USA.

European Heart Journal. Cardiovascular Imaging
|January 31, 2021
PubMed

Insights

Certain heart conditions, like increased left ventricular mass and reduced ejection fraction, significantly elevate the risk of developing chronic kidney disease (CKD) in older adults. Echocardiography can help assess this combined cardiac and kidney health risk.

Area of Science:

  • Cardiology
  • Nephrology
  • Geriatrics

Background:

  • Heart failure is a known risk factor for kidney disease progression.
  • The relationship between cardiac structure/function and incident chronic kidney disease (CKD) in community settings is not fully understood.

Purpose of the Study:

  • To investigate the association between echocardiographic measures of cardiac function and structure and the risk of developing incident CKD in an older, community-dwelling population.

Main Methods:

  • The Atherosclerosis Risk in Communities Study cohort (n=4188) without prevalent CKD was analyzed.
  • Echocardiographic measures including left ventricular (LV) mass index, ejection fraction, left atrial volume index (LAVi), and right ventricular (RV) function were assessed.
  • Incident CKD was defined by a >25% decline in estimated glomerular filtration rate (eGFR) to <60 mL/min/1.73 m², CKD hospitalization, or end-stage kidney disease.

Main Results:

  • Higher LV mass index, lower ejection fraction, higher LAVi, and higher peak RV-right atrium (RA) gradient were independently associated with an increased risk of incident CKD.
  • The risk of CKD increased monotonically with higher LV mass index, lower ejection fraction, higher LAVi, and higher peak RV-RA gradient.
  • No significant association was found between RV function and incident CKD risk.

Conclusions:

  • Cardiac structural and functional abnormalities, specifically LV mass index, ejection fraction, LAVi, and peak RV-RA gradient, are significant independent predictors of incident CKD in older adults.
  • These findings reinforce the link between heart disease and kidney disease progression.
  • Echocardiography may be valuable in assessing combined cardiovascular and kidney health in elderly populations.
Abstract

Keywords:
chronic kidney diseasediastolic dysfunctionechocardiographyejection fractionheart failureleft ventricular mass index

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