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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

      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)
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      References

        • Ronco C.
        • McCullough P.
        • Anker S.D.
        • et al.
        Acute Dialysis Quality Initiative (ADQI) consensus group. Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative.
        Eur Heart J. 2010; 31: 703-711https://doi.org/10.1093/eurheartj/ehp507
        • Damman K.
        • Testani J.M.
        The kidney in heart failure: an update.
        Eur Heart J. 2015; 36: 1437-1444https://doi.org/10.1093/eurheartj/ehv010
        • Harjola V.P.
        • Mullens W.
        • Banaszewski M.
        • et al.
        Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management: a review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC).
        Eur J Heart Fail. 2017; 19: 821-836https://doi.org/10.1002/ejhf.872
        • Ishigami J.
        • Trevisan M.
        • Lund L.H.
        • et al.
        Acceleration of kidney function decline after incident hospitalization with cardiovascular disease: the Stockholm CREAtinine Measurements (SCREAM) project.
        Eur J Heart Fail. 2020; 22: 1790-1799https://doi.org/10.1002/ejhf.1968
        • Ishigami J.
        • Cowan L.T.
        • Demmer R.T.
        • et al.
        Incident hospitalization with major cardiovascular diseases and subsequent risk of ESKD: implications for cardiorenal syndrome.
        J Am Soc Nephrol. 2020; 31: 405-414https://doi.org/10.1681/ASN.2019060574
        • Sud M.
        • Tangri N.
        • Pintilie M.
        • Levey A.S.
        • Naimark D.M.J.
        ESRD and death after heart failure in CKD.
        J Am Soc Nephrol. 2015; 26: 715-722https://doi.org/10.1681/ASN.2014030253
        • Sud M.
        • Tangri N.
        • Pintilie M.
        • Levey A.S.
        • Naimark D.
        Risk of end-stage renal disease and death after cardiovascular events in chronic kidney disease.
        Circulation. 2014; 130: 458-465https://doi.org/10.1161/CIRCULATIONAHA.113.007106
        • Ishigami J.
        • Mathews L.
        • Hishida M.
        • et al.
        Echocardiographic measures and subsequent decline in kidney function in older adults: the Atherosclerosis Risk in Communities Study.
        Eur Heart J Cardiovasc Imaging. 2022; 23: 283-293https://doi.org/10.1093/ehjci/jeaa418
        • Chen S.C.
        • Su H.M.
        • Hung C.C.
        • et al.
        Echocardiographic parameters are independently associated with rate of renal function decline and progression to dialysis in patients with chronic kidney disease.
        Clin J Am Soc Nephrol. 2011; 6: 2750-2758https://doi.org/10.2215/CJN.04660511
        • Agarwal R.
        • Song R.J.
        • Vasan R.S.
        • Xanthakis V.
        Left ventricular mass and incident chronic kidney disease.
        Hypertension. 2020; 75: 702-706https://doi.org/10.1161/HYPERTENSIONAHA.119.14258
        • Paoletti E.
        • Bellino D.
        • Gallina A.M.
        • Amidone M.
        • Cassottana P.
        • Cannella G.
        Is left ventricular hypertrophy a powerful predictor of progression to dialysis in chronic kidney disease?.
        Nephrol Dial Transplant. 2011; 26: 670-677https://doi.org/10.1093/ndt/gfq409
        • Shi Ht
        • Wang Xj
        • Li J.
        • et al.
        Association of left ventricular hypertrophy with a faster rate of renal function decline in elderly patients with non-end-stage renal disease.
        J Am Heart Assoc. 2015; 4e002213https://doi.org/10.1161/JAHA.115.002213
        • Cioffi G.
        • Tarantini L.
        • Frizzi R.
        • et al.
        Chronic kidney disease elicits excessive increase in left ventricular mass growth in patients at increased risk for cardiovascular events.
        J Hypertens. 2011; 29: 565-573https://doi.org/10.1097/HJH.0b013e3283424188
        • Shlipak M.G.
        • Katz R.
        • Kestenbaum B.
        • Fried L.F.
        • Siscovick D.
        • Sarnak M.J.
        Clinical and subclinical cardiovascular disease and kidney function decline in the elderly.
        Atherosclerosis. 2009; 204: 298-303https://doi.org/10.1016/j.atherosclerosis.2008.08.016
        • Zelnick L.R.
        • Katz R.
        • Young B.A.
        • et al.
        Echocardiographic measures and estimated GFR decline among African Americans: the Jackson Heart Study.
        Am J Kidney Dis. 2017; 70: 199-206https://doi.org/10.1053/j.ajkd.2016.11.022
        • United States Renal Data System
        2020 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States.
        National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2020
        • Choi A.I.
        • Rodriguez R.A.
        • Bacchetti P.
        • Bertenthal D.
        • Hernandez G.T.
        • O’Hare A.M.
        White/black racial differences in risk of end-stage renal disease and death.
        Am J Med. 2009; 122: 672-678https://doi.org/10.1016/j.amjmed.2008.11.021
        • Derose S.F.
        • Rutkowski M.P.
        • Crooks P.W.
        • et al.
        Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system.
        Am J Kidney Dis. 2013; 62: 236-244https://doi.org/10.1053/j.ajkd.2013.01.019
        • Fernandes-Silva M.M.
        • Shah A.M.
        • Hegde S.
        • et al.
        Race-related differences in left ventricular structural and functional remodeling in response to increased afterload: the ARIC Study.
        JACC Heart Fail. 2017; 5: 157-165https://doi.org/10.1016/j.jchf.2016.10.011
        • Wyatt S.B.
        • Diekelmann N.
        • Henderson F.
        • et al.
        A community-driven model of research participation: the Jackson Heart Study Participant Recruitment and Retention Study.
        Ethn Dis. 2003; 13: 438-455
        • Skelton T.N.
        • Andrew M.E.
        • Arnett D.K.
        • et al.
        Echocardiographic left ventricular mass in African-Americans: the Jackson cohort of the Atherosclerosis Risk in Communities Study.
        Echocardiography. 2003; 20: 111-120https://doi.org/10.1046/j.1540-8175.2003.03000.x
        • Lang R.M.
        • Badano L.P.
        • Mor-Avi V.
        • et al.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        Eur Heart J Cardiovasc Imaging. 2015; 16 (Published corrections appear in Eur Heart J Cardiovasc Imaging. 2016;17(4):412 and Eur Heart J Cardiovasc Imaging. 2016;17(9):969): 233-270https://doi.org/10.1093/ehjci/jev014
        • Nagueh S.F.
        • Smiseth O.A.
        • Appleton C.P.
        • et al.
        Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        Eur Heart J Cardiovasc Imaging. 2016; 17: 1321-1360https://doi.org/10.1093/ehjci/jew082
        • Devereux R.B.
        • Alonso D.R.
        • Lutas E.M.
        • et al.
        Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.
        Am J Cardiol. 1986; 57: 450-458https://doi.org/10.1016/0002-9149(86)90771-x
        • Cuspidi C.
        • Meani S.
        • Negri F.
        • et al.
        Indexation of left ventricular mass to body surface area and height to allometric power of 2.7: is the difference limited to obese hypertensives?.
        J Hum Hypertens. 2009; 23: 728-734https://doi.org/10.1038/jhh.2009.16
        • Teichholz L.E.
        • Kreulen T.
        • Herman M.V.
        • Gorlin R.
        Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy.
        Am J Cardiol. 1976; 37: 7-11https://doi.org/10.1016/0002-9149(76)90491-4
        • Hemmelgarn B.R.
        • James M.T.
        • Manns B.J.
        • et al.
        Alberta Kidney Disease Network. Rates of treated and untreated kidney failure in older vs younger adults.
        JAMA. 2012; 307: 2507-2515https://doi.org/10.1001/jama.2012.6455
        • Rebholz C.M.
        • Coresh J.
        • Ballew S.H.
        • et al.
        Kidney failure and ESRD in the Atherosclerosis Risk in Communities (ARIC) Study: comparing ascertainment of treated and untreated kidney failure in a cohort study.
        Am J Kidney Dis. 2015; 66: 231-239https://doi.org/10.1053/j.ajkd.2015.01.016
        • Levey A.S.
        • Stevens L.A.
        • Schmid C.H.
        • et al.
        CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate.
        Ann Intern Med. 2009; 150 (Published correction appears in Ann Intern Med. 2011;155(6):408): 604-612https://doi.org/10.7326/0003-4819-150-9-200905050-00006
        • Sharrett A.R.
        • Patsch W.
        • Sorlie P.D.
        • Heiss G.
        • Bond M.G.
        • Davis C.E.
        Associations of lipoprotein cholesterols, apolipoproteins A-I and B, and triglycerides with carotid atherosclerosis and coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study.
        Arterioscler Thromb. 1994; 14: 1098-1104https://doi.org/10.1161/01.atv.14.7.1098
        • Inker L.A.
        • Eneanya N.D.
        • Coresh J.
        • et al.
        Chronic Kidney Disease Epidemiology Collaboration. New creatinine- and cystatin C–based equations to estimate GFR without race.
        N Engl J Med. 2021; 385: 1737-1749https://doi.org/10.1056/NEJMoa2102953
        • Klag M.J.
        • Whelton P.K.
        • Randall B.L.
        • Neaton J.D.
        • Brancati F.L.
        • Stamler J.
        End-stage renal disease in African-American and white men: 16-year MRFIT findings.
        JAMA. 1997; 277: 1293-1298
        • Ahmad F.S.
        • Cai X.
        • Kunkel K.
        • et al.
        • CRIC Study Investigators
        Racial/ethnic differences in left ventricular structure and function in chronic kidney disease: the Chronic Renal Insufficiency Cohort.
        Am J Hypertens. 2017; 30: 822-829https://doi.org/10.1093/ajh/hpx058
        • Norton J.M.
        • Moxey-Mims M.M.
        • Eggers P.W.
        • et al.
        Social determinants of racial disparities in CKD.
        J Am Soc Nephrol. 2016; 27: 2576-2595https://doi.org/10.1681/ASN.2016010027
        • Yildiz M.
        • Oktay A.A.
        • Stewart M.H.
        • Milani R.V.
        • Ventura H.O.
        • Lavie C.J.
        Left ventricular hypertrophy and hypertension.
        Prog Cardiovasc Dis. 2020; 63: 10-21https://doi.org/10.1016/j.pcad.2019.11.009
        • Bash L.D.
        • Astor B.C.
        • Coresh J.
        Risk of incident ESRD: a comprehensive look at cardiovascular risk factors and 17 years of follow-up in the Atherosclerosis Risk in Communities (ARIC) Study.
        Am J Kidney Dis. 2010; 55: 31-41https://doi.org/10.1053/j.ajkd.2009.09.006
        • Eguchi K.
        • Boden-Albala B.
        • Jin Z.
        • et al.
        Association between diabetes mellitus and left ventricular hypertrophy in a multiethnic population.
        Am J Cardiol. 2008; 101: 1787-1791https://doi.org/10.1016/j.amjcard.2008.02.082
        • Cuspidi C.
        • Rescaldani M.
        • Sala C.
        • Grassi G.
        Left-ventricular hypertrophy and obesity: a systematic review and meta-analysis of echocardiographic studies.
        J Hypertens. 2014; 32: 16-25https://doi.org/10.1097/HJH.0b013e328364fb58
        • Dong S.J.
        • MacGregor J.H.
        • Crawley A.P.
        • et al.
        Left ventricular wall thickness and regional systolic function in patients with hypertrophic cardiomyopathy: a three-dimensional tagged magnetic resonance imaging study.
        Circulation. 1994; 90: 1200-1209https://doi.org/10.1161/01.cir.90.3.1200
        • Mada R.O.
        • Lysyansky P.
        • Daraban A.M.
        • Duchenne J.
        • Voigt J.U.
        How to define end-diastole and end-systole? Impact of timing on strain measurements.
        JACC Cardiovasc Imaging. 2015; 8: 148-157https://doi.org/10.1016/j.jcmg.2014.10.010
        • Corya B.C.
        • Rasmussen S.
        • Feigenbaum H.
        • Knoebel S.B.
        • Black M.J.
        Systolic thickening and thinning of the septum and posterior wall in patients with coronary artery disease, congestive cardiomyopathy, and atrial septal defect.
        Circulation. 1977; 55: 109-114https://doi.org/10.1161/01.cir.55.1.109
        • Hsu Cy
        • Iribarren C.
        • McCulloch C.E.
        • Darbinian J.
        • Go A.S.
        Risk factors for end-stage renal disease: 25-year follow-up.
        Arch Intern Med. 2009; 169: 342-350https://doi.org/10.1001/archinternmed.2008.605
        • Barrera-Chimal J.
        • Girerd S.
        • Jaisser F.
        Mineralocorticoid receptor antagonists and kidney diseases: pathophysiological basis.
        Kidney Int. 2019; 96: 302-319https://doi.org/10.1016/j.kint.2019.02.030
        • Taddei S.
        • Nami R.
        • Bruno R.M.
        • Quatrini I.
        • Nuti R.
        Hypertension, left ventricular hypertrophy and chronic kidney disease.
        Heart Fail Rev. 2011; 16: 615-620https://doi.org/10.1007/s10741-010-9197-z
        • Mavrakanas T.A.
        • Khattak A.
        • Singh K.
        • Charytan D.M.
        Echocardiographic parameters and renal outcomes in patients with preserved renal function, and mild- moderate CKD.
        BMC Nephrol. 2018; 19: 176https://doi.org/10.1186/s12882-018-0975-5
        • Unger T.
        • Borghi C.
        • Charchar F.
        • et al.
        2020 International Society of Hypertension Global Hypertension Practice Guidelines.
        Hypertension. 2020; 75: 1334-1357https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
        • American Diabetes Association
        10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2021.
        Diabetes Care. 2021; 44 (Published correction appears in Diabetes Care. 2021;44(9):2183-2185): S125-S150https://doi.org/10.2337/dc21-S010
        • Weber J.R.
        Left ventricular hypertrophy: its prevalence, etiology, and significance.
        Clin Cardiol. 1991; 14: 13-17https://doi.org/10.1002/clc.4960140704

      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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