Abstract
Objective
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.
Results
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.
Conclusion
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)To read this article in full you will need to make a payment
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Article info
Footnotes
Grant Support: The Atherosclerosis Risk in Communities Study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute; National Institutes of Health; and Department of Health and Human Services (under contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I). This work was supported by grant K01DK125616 (J.I.) from the National Institute of Diabetes and Digestive and Kidney Diseases.
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- Heart Disease and Kidney Failure in the Black CommunityMayo Clinic ProceedingsVol. 97Issue 10
- PreviewIn 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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