Estimated GFR and Subsequent Higher Left Ventricular Mass in Young and Middle-Aged Adults With Normal Kidney Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

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• 作者：Nisha Bansal ; MD ; MAS¹ ; ^{nbansal@nephrology.washington.edu" class="auth_mail" title="E-mail the corresponding author} ; Feng Lin ; MS² ; Eric Vittinghoff ; PhD² ; Carmen Peralta ; MD² ; Joao Lima ; MD³ ; Holly Kramer ; MD⁴ ; Michael Shlipak ; MD² ; Kirsten Bibbins-Domingo ; MD ; PhD²
• 关键词：Kidney function ; estimated glomerular filtration rate (eGFR) ; cystatin C ; renal function decline ; left ventricular mass index (LVMI) ; echocardiogram ; left ventricular hypertrophy (LVH) ; subclinical cardiovascular disease risk factor
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：67
• 期：2
• 页码：227-234
• 全文大小：557 K

文摘

Left ventricular hypertrophy is common and is associated with cardiovascular events and death among patients with known chronic kidney disease. However, the link between reduced glomerular filtration rate (GFR) and left ventricular mass index (LVMI) remains poorly explored among young and middle-aged adults with preserved kidney function. In this study, we examined the association of cystatin C–based estimated GFR (eGFR_cys) and rapid decline in eGFR with subsequent LVMI.

Study Design

Observational study.

Setting & Participants

We included 2,410 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort with eGFR_cys > 60 mL/min/1.73 m² at year 15 and who had an echocardiogram obtained at year 25.

Predictor

eGFR_cys at year 15 and rapid decline in eGFR_cys (defined as >3% per year over 5 years from years 15 to 20).

Outcome

LVMI measured at year 25.

Measurements

We adjusted for age, sex, race, diabetes, body mass index, low- and high-density lipoprotein cholesterol levels, cumulative systolic blood pressure, and albuminuria.

Results

Mean age was 40 ± 4 (SD) years, 58% were women, and 43% were black. After 10 years of follow-up, mean LVMI was 39.6 ± 13.4 g/m^2.7. Compared with eGFR_cys > 90 mL/min/1.73 m² (n = 2,228), eGFR_cys of 60 to 75 mL/min/1.73 m² (n = 29) was associated with 5.63 (95% CI, 0.90-10.36) g/m^2.7 greater LVMI (P = 0.02), but there was no association of eGFR_cys of 76 to 90 mL/min/1.73 m² (n = 153) with LVMI after adjustment for confounders. Rapid decline in eGFR_cys was associated with higher LVMI compared with participants without a rapid eGFR_cys decline (β coefficient, 1.48; 95% CI, 0.11-2.83; P = 0.03) after adjustment for confounders.

Limitations

There were a limited number of participants with eGFR_cys of 60 to 90 mL/min/1.73 m².

Conclusions

Among young and middle-aged adults with preserved kidney function, eGFR_cys of 60 to 75 mL/min/1.73 m² and rapid decline in eGFR_cys were significantly associated with subsequently higher LVMI. Further studies are needed to understand the mechanisms that contribute to elevated LVMI in this range of eGFR_cys.