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Echocardiography-Based Cardiac Structure Parameters for the Long-term Risk of End-Stage Kidney Disease in Black Individuals: The Atherosclerosis Risk in Communities Study



      To assess whether echocardiographic parameters of left ventricular (LV) structure and function relate to the long-term risk of incident end-stage kidney disease (ESKD).

      Patients and Methods

      We conducted a prospective cohort study analyzing 2137 Black participants from the Jackson site of the Atherosclerosis Risk in Communities Study from January 1, 1993, through July 31, 2017. Echocardiographic parameters of LV structure and function were obtained from 1993 to 1995. The primary outcome incident ESKD was identified through the linkage to the United States Renal Data System. Cox proportional hazards models were used to estimate the hazard ratios (HRs) according to each echocardiographic parameter.


      There were 117 incident ESKD cases during a median follow-up of 22.2 (interquartile range, 15.0-23.3) years. Multivariable Cox models revealed that a higher LV mass index was significantly associated with the risk of ESKD (HR, 2.38; 95% CI, 1.21 to 4.68 for highest vs lowest quartile, P = 0.012). The HRs were significant and even higher for LV posterior wall thickness, with slightly higher HRs when their measures in end-systole (HR for highest vs lowest quartile, 4.38; 95% CI, 1.94 to 9.92, P < 0.001) vs end-diastole (HR, 3.50; 95% CI, 1.53 to 8.01, P = 0.003) were used. The associations were not significant for LV function parameters.


      In Black individuals residing in the community, echocardiographic parameters of LV structure, including LV wall thickness, were robustly associated with the risk of subsequently incident ESKD. These results have potential implications for novel prevention and management strategies for persons with abnormal LV structure.

      Abbreviations and Acronyms:

      ARIC (Atherosclerosis Risk in Communities), CHD (coronary heart disease), CKD (chronic kidney disease), CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration), CVD (clinical cardiovascular disease), E/A (early diastolic peak flow velocity to late diastolic peak flow velocity), eGFR (estimated glomerular filtration rate), ESKD (end-stage kidney disease), HDL-C (high-density lipoprotein cholesterol), HR (hazard ratio), IVST (interventricular septal thickness), LV (left ventricular), LVEDD (left ventricular end-diastolic diameter), LVMI (left ventricular mass index), PWT (posterior wall thickness)
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      Linked Article

      • Heart Disease and Kidney Failure in the Black Community
        Mayo Clinic ProceedingsVol. 97Issue 10
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          In the United States, Black Americans suffer from a disproportionately high prevalence of cardiometabolic disorders including cardiovascular disease (CVD) and chronic kidney disease/end-stage kidney disease (CKD/ESKD) compared with their White peers.1,2 The reasons for these disparities are multifactorial. These disparities are primarily driven by societal factors, racial- and ethnic-based inequities in the allocation of health-affirming resources and opportunities, which is commonly termed structural racism.
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