1
|
Ishigami J, Kansal M, Mehta R, Srivastava A, Rahman M, Dobre M, Al-Kindi SG, Go AS, Navaneethan SD, Chen J, He J, Bhat ZY, Jaar BG, Appel LJ, Matsushita K. Cardiac Structure and Function and Subsequent Kidney Disease Progression in Adults With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2023; 82:225-236. [PMID: 36935072 PMCID: PMC10440229 DOI: 10.1053/j.ajkd.2023.01.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/05/2023] [Indexed: 03/19/2023]
Abstract
RATIONALE & OBJECTIVE Heart-kidney crosstalk is recognized as the cardiorenal syndrome. We examined the association of cardiac function and structure with the risk of kidney failure with replacement therapy (KFRT) in a chronic kidney disease (CKD) population. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 3,027 participants from the Chronic Renal Insufficiency Cohort Study. EXPOSURE Five preselected variables that assess different aspects of cardiac structure and function: 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. OUTCOME Incident KFRT (primary outcome), and annual estimated glomerular filtration rate (eGFR) slope (secondary outcome). ANALYTICAL APPROACH Multivariable Cox models and mixed-effects models. RESULTS The mean age of the participants was 59±11 SD years, 54% were men, and mean eGFR was 43±17mL/min/1.73m2. Between 2003 and 2018 (median follow-up, 9.9 years), 883 participants developed KFRT. Higher LVMI, LV volume, LA area, peak TR velocity, and lower EF were each statistically significantly associated with an increased risk of KFRT, with corresponding HRs for the highest versus lowest quartiles (lowest vs highest for EF) of 1.70 (95% CI, 1.27-2.26), 1.50 (95% CI, 1.19-1.90), 1.43 (95% CI, 1.11-1.84), 1.45 (95% CI, 1.06-1.96), and 1.26 (95% CI, 1.03-1.56), respectively. For the secondary outcome, participants in the highest versus lowest quartiles (lowest vs highest for EF) had a statistically significantly faster eGFR decline, except for LA area (ΔeGFR slope per year, -0.57 [95% CI, -0.68 to-0.46] mL/min/1.73m2 for LVMI, -0.25 [95% CI, -0.35 to-0.15] mL/min/1.73m2 for LV volume, -0.01 [95% CI, -0.12 to-0.01] mL/min/1.73m2 for LA area, -0.42 [95% CI, -0.56 to-0.28] mL/min/1.73m2 for peak TR velocity, and -0.11 [95% CI, -0.20 to-0.01] mL/min/1.73m2 for EF, respectively). LIMITATIONS The possibility of residual confounding. CONCLUSIONS Multiple aspects of cardiac structure and function were statistically significantly associated with the risk of KFRT. These findings suggest that cardiac abnormalities and incidence of KFRT are potentially on the same causal pathway related to the interaction between hypertension, heart failure, and coronary artery diseases. PLAIN-LANGUAGE SUMMARY Heart disease and kidney disease are known to interact with each other. In this study, we examined whether cardiac abnormalities, as assessed by echocardiography, were linked to the subsequent progression of kidney disease among people living with chronic kidney disease (CKD). We found that people with abnormalities in heart structure and function had a greater risk of progression to advanced CKD that required kidney replacement therapy and had a faster rate of decline in kidney function. Our study indicates the potential role of abnormal heart structure and function in the progression of kidney disease among people living with CKD.
Collapse
Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
| | - Mayank Kansal
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Rupal Mehta
- Division of Nephrology, Northwestern University, Chicago, Illinois
| | - Anand Srivastava
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mahboob Rahman
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio; Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Epidemiology, Biostatistics and Medicine, University of California-San Francisco, San Francisco, California; Department of Medicine (Nephrology), Stanford University, Palo Alto, California
| | | | - Jing Chen
- Division of Nephrology, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Division of Nephrology, Tulane University, New Orleans, Louisiana
| | | | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
2
|
Qi L, Zhi B, Zhang J, Zhang L, Luo S, Zhang L. Defining Biventricular Abnormalities by Cardiac Magnetic Resonance in Pre-Dialysis Patients with Chronic Kidney Disease. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:277-284. [PMID: 37900003 PMCID: PMC10601957 DOI: 10.1159/000529526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/30/2023] [Indexed: 10/31/2023]
Abstract
Introduction The aim of the study was to investigate biventricular structural and functional abnormalities in pre-dialysis patients across stages of chronic kidney disease (CKD) by cardiac magnetic resonance (CMR). Methods Fifty-one CKD patients with CMR exams were retrospectively analyzed. Patients were divided into three groups according to estimated glomerular filtration rate (eGFR): CKD 1 group (patients with normal eGFR≥90 mL/min/1.73 m2, n = 20), CKD 2-3 group (patients with eGFR< 90 to ≥30 mL/min/1.73 m2, n = 14), and CKD 4-5 group (patients with eGFR<30 mL/min/1.73 m2, n = 17). Twenty-one age- and sex-matched healthy controls (HC) were recruited. CMR-derived left ventricular (LV) and right ventricular (RV) structural and functional measures were compared. Association between CMR parameters and clinical measures was assessed. Results There was an increasing trend in RV mass index (RVMi) and LV mass index (LVMi) with the occurrence and development of CKD from HC group to CKD 4-5 group although no significant difference was observed between CKD 1 group and HC group. LV global radial strain and LV global circumferential strain dropped and native T1 value elevated significantly in CKD 4-5 group compared with the other three groups (all p < 0.05), while RV strain measures, RV ejection fraction, and LV ejection fraction showed no significant difference among 4 groups (all p > 0.05). Elevated LV end-diastolic volume index (β = 0.356, p = 0.016) and RV end-systolic volume index (β = 0.488, p = 0.001) were independently associated with RVMi. Increased systolic blood pressure (β = 0.309, p = 0.004), LV end-systolic volume index (β = 0.633, p < 0.001), and uric acid (β = 0.261, p = 0.013) were independently associated with LVMi. Meanwhile, serum phosphorus (β = 0.519, p = 0.001) was independently associated with native T1 value. Conclusion In pre-dialysis CKD patients, left and right ventricular remolding has occurred. RVMi and LVMi were the first changed CMR indexes in the development of CKD when eGFR began to drop. Because fluid volume overload was the independent risk factor for RVMi and LVMi increase, reasonable controlling fluid volume overload may slow down the progression of biventricular remolding and may reduce related cardiovascular disease risk.
Collapse
Affiliation(s)
- Li Qi
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Beibei Zhi
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Lingyan Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Song Luo
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
3
|
Hashimoto K, Kinoshita T, Miwa Y, Amino M, Yoshioka K, Yodogawa K, Nakagawa M, Nakamura K, Watanabe E, Nakamura K, Watanabe T, Kasamaki Y, Ikeda T. Ambulatory electrocardiographic markers predict serious cardiac events in patients with chronic kidney disease: The Japanese Noninvasive Electrocardiographic Risk Stratification of Sudden Cardiac Death in Chronic Kidney Disease (JANIES-CKD) study. Ann Noninvasive Electrocardiol 2021; 27:e12923. [PMID: 34873791 PMCID: PMC8916573 DOI: 10.1111/anec.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Noninvasive electrocardiographic markers (NIEMs) are promising arrhythmic risk stratification tools for assessing the risk of sudden cardiac death. However, little is known about their utility in patients with chronic kidney disease (CKD) and organic heart disease. This study aimed to determine whether NIEMs can predict cardiac events in patients with CKD and structural heart disease (CKD‐SHD). Methods We prospectively analyzed 183 CKD‐SHD patients (median age, 69 years [interquartile range, 61−77 years]) who underwent 24‐h ambulatory electrocardiographic monitoring and assessed the worst values for ambulatory‐based late potentials (w‐LPs), heart rate turbulence, and nonsustained ventricular tachycardia (NSVT). The primary endpoint was the occurrence of documented lethal ventricular tachyarrhythmias (ventricular fibrillation or sustained ventricular tachycardia) or cardiac death. The secondary endpoint was admission for cardiovascular causes. Results Thirteen patients reached the primary endpoint during a follow‐up period of 24 ± 11 months. Cox univariate regression analysis showed that existence of w‐LPs (hazard ratio [HR] = 6.04, 95% confidence interval [CI]: 1.4−22.3, p = .007) and NSVT [HR = 8.72, 95% CI: 2.8−26.5: p < .001] was significantly associated with the primary endpoint. Kaplan–Meier analysis demonstrated that the combination of w‐LPs and NSVT resulted in a lower event‐free survival rate than did other NIEMs (p < .0001). No NIEM was useful in predicting the secondary endpoint, although the left ventricular mass index was correlated with the secondary endpoint. Conclusion The combination of w‐LPs and NSVT was a significant risk factor for lethal ventricular tachyarrhythmias and cardiac death in CKD‐SHD patients.
Collapse
Affiliation(s)
- Kenichi Hashimoto
- Department of General Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University, Tokyo, Japan
| | - Yosuke Miwa
- Department of Cardiology, Kyorin University Hospital, Tokyo, Japan
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University, Kanagawa, Japan
| | - Koichiro Yoshioka
- Department of Cardiovascular Medicine, Tokai University, Kanagawa, Japan
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Yufu, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Kentaro Nakamura
- Division of Cardiovascular Medicine, Shin-Yamanote Hospital, Tokyo, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yuji Kasamaki
- Department of General Medicine, Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University, Tokyo, Japan
| |
Collapse
|