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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Inferior vena cava diameter in patients with chronic heart failure and chronic kidney disease: a retrospective study
Jianan Li1,2,3, Chi Wang3,4, Hui Wu Dong5
1Medical Big Data Research Center, Medical Innovation Research Division, Chinese PLA General Hospital, 28 Fuxing RD., Beijing, 100853, China.
Insights
Elevated inferior vena cava (IVC) diameter is linked to increased mortality risk in patients with chronic heart failure (CHF) and chronic kidney disease (CKD). This association is mediated by N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and serum albumin levels.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Chronic kidney disease (CKD) significantly increases mortality risk in patients with chronic heart failure (CHF).
- No prior studies have investigated the association between inferior vena cava (IVC) diameter and mortality in patients with concurrent CKD and CHF.
Purpose of the Study:
- To examine the relationship between IVC diameter and all-cause mortality in patients diagnosed with both CHF and CKD.
- To investigate the mediating roles of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and serum albumin in this association.
Main Methods:
- A retrospective cohort study included 1327 patients with CHF and CKD.
- Echocardiography data, demographics, medical history, and laboratory tests were collected.
- Cox regression and mediation analysis were used to assess mortality risk and mediator roles.
Main Results:
- A total of 757 (57.05%) deaths occurred during a median follow-up of 3.46 years.
- Increased IVC diameter (>21 mm or as a continuous variable) was significantly associated with higher all-cause and cardiovascular mortality.
- The association was mediated by NT-proBNP (37.8%) and serum albumin (14.1%).
Conclusions:
- Elevated IVC diameter is a predictor of worse prognosis in patients with CHF and CKD.
- NT-proBNP and serum albumin levels partially mediate the link between IVC diameter and mortality in this population.
Background:
Chronic kidney disease (CKD) carries the highest population attributable risk for mortality among all comorbidities in chronic heart failure (CHF). No studies about the association between inferior vena cava (IVC) diameter and all-cause mortality in patients with the comorbidity of CKD and CHF has been published.
Methods:
In this retrospective cohort study, a total of 1327 patients with CHF and CKD were included. All patients underwent standardized echocardiography examination and data on demographic characteristics, medical history, and laboratory tests were recorded. Information on all-cause mortality was collected by telephone interview and medical records review. We used Cox regression to evaluate the risk of all-cause mortality among groups, and used mediation analysis to examine the mediation role of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) and serum albumin in the association between IVC and all-cause mortality.
Results:
During a median follow-up of 3.46 years (IQR: 1.55-5.15 years), 757 (57.05%) cases of all-cause mortality were observed. Compared with patients with IVC diameter < 21 mm, those with IVC diameter > 21 mm were associated with higher risk of all-cause mortality (HR (95%CI):1.31(1.07-1.61), log rank: P = 0.01) and cardiovascular mortality (HR (95%CI): 1.55(1.19-2.04), log rank: P = 0.001). When assessing IVC as a continuous variable, each 1% increase in IVC was associated with 4% increased risk of all-cause mortality (HR: 1.04, 95%CI 1.02-1.06, P < 0.001). This association were mediated by log NT-proBNP (mediated effect: 37.8% (95%CI 22.0-73.0%), P < 0.001) and serum albumin (mediated effect: 14.1% (95%CI 6.2-28.0%), P < 0.001). In subgroup analyses, there was no significant interaction in different subgroups of cardiac and renal function for the association between IVC and all-cause mortality.
Conclusions:
Elevated IVC diameter was associated with worse prognosis in patients with CHF and CKD, and the associations were mediated by log NT-proBNP and serum albumin.
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