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Updated: Jun 18, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Risk of mortality associated to chronic kidney disease in patients with complete left bundle branch block
Hui-Chun Huang1,2, Chun-Kai Chen3, Yen-Bin Liu1
1Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Chronic kidney disease (CKD) significantly increases mortality risk in patients with complete left bundle branch block (cLBBB). Early identification and management of CKD in these patients are crucial for improving outcomes.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Chronic kidney disease (CKD) is a known risk factor for heart failure and cardiac conduction abnormalities.
- Complete left bundle branch block (cLBBB) can worsen ventricular synchrony and contribute to heart failure progression.
- A synergistic negative impact exists between CKD and heart failure, creating a detrimental cycle.
Purpose of the Study:
- To investigate the impact of CKD on mortality in patients diagnosed with cLBBB.
- To assess the role of estimated glomerular filtration rate (eGFR) in predicting outcomes for this patient group.
Main Methods:
- A hospital-based cohort of 416 adult patients with cLBBB was analyzed retrospectively (2010-2013).
- Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation.
- Cox proportional hazard models were employed to determine predictors of all-cause and cardiovascular mortality.
Main Results:
- Advanced CKD (eGFR < 60 mL/min/1.73 m²) was a significant independent predictor of total mortality in patients with cLBBB.
- The presence of CKD in cLBBB patients substantially increased the risk of both total mortality (HR 5.01) and cardiovascular death (HR 61.78) compared to those without CKD.
- Older age, congestive heart failure, higher heart rate, and lack of ACEI/ARB use also predicted higher total mortality.
Conclusions:
- CKD is a critical risk factor for increased all-cause mortality in individuals with cLBBB.
- The findings highlight the importance of considering renal function when managing patients with cLBBB to mitigate mortality risks.
Abstract:
Chronic kidney disease (CKD) is associated with cardiac conduction defects and is a strong risk factor for heart failure. Complete left bundle branch block (cLBBB), a cardiac conduction abnormality, may have an unfavorable effect on ventricular mechanical synchrony and lead to the progression of heart failure. Once heart failure develops, it seems to act together with underlying CKD in a vicious circle. Therefore, this study aimed to explore the influence of CKD in patients with cLBBB by assessing the estimated glomerular filtration rate (eGFR). We examined a hospital-based sample of 416 adult patients with cLBBB from 2010 to 2013. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Cox proportional hazard models were used to estimate the hazard ratio for all-cause mortality and cardiovascular mortality. A total of 416 adult patients with a mean age of 71 ± 13 years were enrolled. The median follow-up period was 3.6 years. After adjusting for clinical, electrocardiographic parameters, and medication use, cox regression analysis showed that total mortality was significantly associated with older age (Hazard Ratio (HR) = 1.03, 95% CI = 1.01-1.05, p = 0.002), presence of congestive heart failure (HR = 2.39, 95% CI = 1.63-3.49, p < 0.001), advanced CKD (HR = 2.48, 95% CI = 1.71-3.59, p < 0.001), higher HR (HR = 1.02, 95% CI = 1.01-1.03, p < 0.001) and without use of ACEI/ARB (HR = 0.59, 95% CI = 0.41-0.85, p = 0.005) were independent predictors of the total mortality. Multivariate Cox hazard regression analysis demonstrated that, in comparison to patients lacking cLBBB, the coexistence of CKD (eGFR < 60 mL/min/1.73 m2) among those with LBBB significantly heightened the risks of both total mortality (HR ratio of 5.01 vs. 2.40) and CV death (HR ratio of 61.78 vs. 14.41) even following adjustment for clinical covariates and ECG parameters. In summary, within patients exhibiting cLBBB, the presence of CKD serves as a significant risk factor for all-cause mortality.
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