Kidney Week

Abstract: SA-PO778

Early Impairment of Kidney Function Is Associated with Changes in Cardiac Structure and Function – Findings from a Large Population-Based Cohort of Elderly Subjects

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Author

• Christensson, Anders, Skane University Hospital, Malmo, Sweden

Anders Christensson,

Background

The pathophysiological association between heart and kidney diseases is often referred to as the cardiorenal syndrome. There are only few previous community-based studies reporting on the association between renal function and left ventricular (LV) function. In recent years also a minor reduction of glomerular filtration rate (GFR) has emerged as a risk marker for changes in cardiac structure. However, there is little knowledge about this in early renal impairment and echocardiographic functional parameters indicating diastolic dysfunction in community-based cohorts.

Methods

The study population consisted of 1504 individuals with no prior history of congestive heart failure or asymptomatic left ventricular ejection fraction ≥40% and an estimated glomerular filtration rate (eGFR) based on cystatinC >15 mL/min/1.73m². Participants were categorized according to eGFR; ≥90; 75-89; 60-74; 45-59; 30-44; and 15-29 mL/min/1.73m². We evaluated associations between eGFR and echocardiographic findings. Transmitral pulsed Doppler flow and tissue Doppler imaging (TDI) in the four-chamber view were used to measure LV diastolic function. Peak myocardial velocity of the basal LV wall in early (É) and late (Á) diastole in the lateral (lat) and septal (sept) walls and Doppler measurement of peak velocity of blood flow through the mitral valve in early (E) and late (A) diastole were measured.

Results

Associations between reduced eGFR and echocardiographic findings indicating early structural changes were found for; left atrium area/body surface area (p=0.013) and diastolic function; peak early mitral valve velocity (A) (p=0.003), peak late atrial mitral valve velocity/ peak systolic myocardial velocity at mitral annulus in lateral wall; (E/Élat) (p=0.002), mean of É mean of lateral and septal wall/ Á mean of lateral and septal wall (mean Ém/Ám) (p=0.027 ). Associations between E/Élat and meanÉm/Ám and eGFR were present already in mild-moderate kidney dysfunction (eGFR 45-60 mL/min/1,73m²). These associations were only significant among men.

Conclusion

A significant association between early impairment of renal function and echocardiographic markers of cardiac structure and diastolic function was observed supporting the hypothesis that interaction between the kidney and heart exists even in the early stages of renal impairment.