Kidney Week

Abstract: SA-PO784

The Bidirectional Nature of the Cardio-Renal Link in Stable CKD Patients

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

Authors

• Dounousi, Evangelia, University of Ioannina, Ioannina, Greece

Evangelia Dounousi,

• Zikou, Xanthi, University Hospital Ioannina, Ioannina, Greece

Xanthi Zikou,

• Pappas, Konstantinos, University Hospital of Ioannina, Ioannina, Greece

Konstantinos Pappas,

• Mallamaci, Francesca, CNR IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy

Francesca Mallamaci,

• Zoccali, Carmine, CNR IFC, Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy

Carmine Zoccali,

Background

In patients with heart disease, left ventricular (LV) dysfunction and heart failure are associated with reduced GFR and vice-versa, in CKD patients, LV hypertrophy and dysfunction go along with the CKD severity. Experimental models support the causal nature of these cardio-renal links. However, there is no clinical study investigating the bi-directionality of these links in stable non-dialysis CKD patients.

Methods

We tested the longitudinal relationship between the estimated GFR (eGFR) and the LV mass index (LVMI) and vice versa in a cohort of 206 stage G1-5 (non-dialysis) CKD patients. Overall, 498 simultaneous eGFR and LVMI measurements in 206 patients were available over a 3 year follow-up. Data analysis was performed by the mixed linear model. In this analysis each predictor (either the eGFR or LVMI) was paired with the subsequent measurement of the pertinent outcome measure (i.e. LVMI when the predictor was the eGFR and the eGFR when the predictor was the LVMI) and adjusting for both, the eGFR and the LVMI of the preceding visit .

Results

At baseline the eGFR (MDRD) was 54±29 ml/min/1.72 m² and LVMI was 70±24 gr/m^2.71. In the analysis testing the LVMI as a predictor of the evolution of the eGFR over time, an increase in LVMI of 10 gr/m^2.71 predicted a eGFR loss of 0.41±0.25 ml/min/1.72 m²over follow up but such an effect failed to attain statistical significance (P=0.10). Vice versa, in the analysis testing the eGFR as a predictor of the evolution of the LVMI over time, a decrease in eGFR of 10 ml/min/1.73m²predicted an increase in LVMI of 1.1±0.4 g/m^2.71 over follow up and this change was highly significant (P=0.001).

Conclusion

This longitudinal analysis in stable non-dialysis CKD patients shows that eGFR loss predicts a rise in LVMI over time. A similar trend exists for the opposite relationship, i.e. LVMI worsening predicts a subsequent eGFR loss but this relationship is much weaker than the previous one and does not achieve formal statistical significance. Overall, these observations suggest that the kidney disease-driven risk for cardiomyopathy progression is more consistent than the simultaneous heart-disease driven risk for CKD progression.