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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Causal Links Between Renal Function and Cardiac Structure, Function, and Disease Risk.

Xiaoqin Zhou1,2,3, Weiqiang Ruan1, Lijun Zhao4,5

  • 1Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, P.R. China.

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Summary

Genetic susceptibility to impaired kidney function causally influences cardiovascular disease risk and cardiac structure. This study clarifies the links between renal markers like eGFR and CVD endpoints, revealing significant associations.

Keywords:
Chronic kidney diseaseCoronary artery diseaseEstimated glomerular filtration rateMendelian randomizationStroke

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Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Genetics

Background:

  • Chronic kidney disease (CKD) is a known risk factor for adverse cardiovascular outcomes.
  • The precise causal pathways linking renal function to cardiovascular diseases (CVD) require further elucidation.
  • Understanding these relationships is crucial for developing targeted preventative strategies.

Purpose of the Study:

  • To investigate the causal relationships between genetic predisposition to impaired renal function and the risk of various cardiovascular disease (CVD) endpoints.
  • To examine the impact of genetic factors related to renal function on cardiac structure and function, assessed via cardiac magnetic resonance imaging (CMR).
  • To establish causal links using Mendelian randomization (MR) analyses.

Main Methods:

  • Bidirectional Mendelian randomization (MR) analyses were performed using genome-wide association study summary data.
  • Key exposures included blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), and CKD.
  • Outcomes comprised major cardiovascular events (e.g., atrial fibrillation, coronary artery disease, stroke) and detailed cardiac parameters from CMR.

Main Results:

  • Elevated BUN showed a causal link to increased coronary artery disease (CAD) risk, though attenuated by cardiometabolic factors.
  • Increased UACR was causally associated with higher risks of CAD, myocardial infarction, and stroke, with stroke association persisting after adjustment.
  • Reduced eGFR was causally linked to diminished cardiac dimensions and volumes, including aorta and pulmonary artery diameters and ventricular volumes.
  • CKD demonstrated a causal association with reduced pulmonary artery-to-aorta ratio and proximal pulmonary artery diameter.

Conclusions:

  • This MR study provides robust evidence for the causal role of genetic susceptibility to impaired renal function in influencing cardiovascular outcomes.
  • The findings highlight specific renal function markers (BUN, UACR, eGFR) as causally linked to distinct cardiovascular risks and structural changes.
  • These results underscore the importance of considering renal health in the context of cardiovascular disease prevention and management.