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Echocardiographic Measures and Estimated GFR Decline Among African Americans: The Jackson Heart Study.
Am J Kidney Dis. 2017 Aug; 70(2):199-206.AJ

Abstract

BACKGROUND

Cardiac structural abnormalities, common in African Americans, are associated with adverse clinical outcomes. Associations between echocardiography-measured subclinical heart failure and kidney function decline are unknown and may identify novel risk factors for kidney disease in this population.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

2,418 Jackson Heart Study participants with baseline echocardiograms and longitudinal measures of estimated glomerular filtration rate (eGFR) calculated from the CKD-EPI creatinine equation. 2,219 participants had baseline eGFRs≥60mL/min/1.73m2.

PREDICTORS

Left ventricular mass (LVM) and ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) quantified from baseline echocardiograms.

OUTCOMES

Primary outcome was >30% eGFR decline or progression to end-stage renal disease (ESRD; need for dialysis therapy) over a mean of 8 years. Secondary outcome, eGFR<60mL/min/1.73m2 or progression to ESRD and eGFR decline >1mL/min/1.73m2 per year among those with baseline eGFRs≥60mL/min/1.73m2.

MEASUREMENTS

Logistic regression models, adjusted for demographics, physical characteristics, comorbid conditions, and medication use.

RESULTS

Mean age was 52.2±11.9 (SD) years, 37% of participants were men; mean baseline eGFR was 87.3±17.3mL/min/1.73m2. The primary and secondary outcomes occurred in 148 (6.1%) and 162 (7.1%) participants, respectively. In unadjusted models, every 25-g greater LVM was significantly associated with greater odds of eGFR decline > 30% or ESRD (OR, 1.38; 95% CI, 1.26-1.51) and incident eGFR<60mL/min/1.73m2 or ESRD (OR, 1.30; 95% CI, 1.20-1.42); only the former remained statistically significant after adjustment. There was no association of LVEF or PASP with either eGFR decline > 30% or ESRD (LVEF: adjusted OR, 0.95 [95% CI, 0.84-1.07]; PASP: adjusted OR, 0.98 [95% CI, 0.87-1.11]) or incident eGFR<60mL/min/1.73m2 or ESRD (LVEF: adjusted OR, 0.98 [95% CI, 0.86-1.11]; PASP: adjusted OR, 1.05 [95% CI, 0.94-1.18]) in multivariable models.

LIMITATIONS

No midstudy creatinine measurement at examination 2.

CONCLUSIONS

Greater LVM was significantly associated with eGFR decline > 30% or ESRD among African Americans in a community-based cohort. Treating and reversing elevated LVM may reduce the burden and progression of kidney disease in this high-risk population.

Authors+Show Affiliations

Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA. Electronic address: lzelnick@uw.edu.Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA; Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Hospital and Specialty Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA.Department of Medicine, University of Mississippi Medical Center, Jackson, MS.Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28143672

Citation

Zelnick, Leila R., et al. "Echocardiographic Measures and Estimated GFR Decline Among African Americans: the Jackson Heart Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 70, no. 2, 2017, pp. 199-206.
Zelnick LR, Katz R, Young BA, et al. Echocardiographic Measures and Estimated GFR Decline Among African Americans: The Jackson Heart Study. Am J Kidney Dis. 2017;70(2):199-206.
Zelnick, L. R., Katz, R., Young, B. A., Correa, A., Kestenbaum, B. R., de Boer, I. H., & Bansal, N. (2017). Echocardiographic Measures and Estimated GFR Decline Among African Americans: The Jackson Heart Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 70(2), 199-206. https://doi.org/10.1053/j.ajkd.2016.11.022
Zelnick LR, et al. Echocardiographic Measures and Estimated GFR Decline Among African Americans: the Jackson Heart Study. Am J Kidney Dis. 2017;70(2):199-206. PubMed PMID: 28143672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Echocardiographic Measures and Estimated GFR Decline Among African Americans: The Jackson Heart Study. AU - Zelnick,Leila R, AU - Katz,Ronit, AU - Young,Bessie A, AU - Correa,Adolfo, AU - Kestenbaum,Bryan R, AU - de Boer,Ian H, AU - Bansal,Nisha, Y1 - 2017/01/28/ PY - 2016/08/08/received PY - 2016/11/27/accepted PY - 2017/2/2/pubmed PY - 2017/8/18/medline PY - 2017/2/2/entrez KW - African Americans KW - Subclinical heart failure KW - eGFR decline KW - echocardiogram KW - ejection fraction (LVEF) KW - end-stage renal disease (ESRD) KW - estimated glomerular filtration rate (eGFR) KW - incident ESRD KW - kidney disease progression KW - kidney function decline KW - left ventricular mass (LVM) KW - pulmonary artery systolic pressure (PASP) SP - 199 EP - 206 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 70 IS - 2 N2 - BACKGROUND: Cardiac structural abnormalities, common in African Americans, are associated with adverse clinical outcomes. Associations between echocardiography-measured subclinical heart failure and kidney function decline are unknown and may identify novel risk factors for kidney disease in this population. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 2,418 Jackson Heart Study participants with baseline echocardiograms and longitudinal measures of estimated glomerular filtration rate (eGFR) calculated from the CKD-EPI creatinine equation. 2,219 participants had baseline eGFRs≥60mL/min/1.73m2. PREDICTORS: Left ventricular mass (LVM) and ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) quantified from baseline echocardiograms. OUTCOMES: Primary outcome was >30% eGFR decline or progression to end-stage renal disease (ESRD; need for dialysis therapy) over a mean of 8 years. Secondary outcome, eGFR<60mL/min/1.73m2 or progression to ESRD and eGFR decline >1mL/min/1.73m2 per year among those with baseline eGFRs≥60mL/min/1.73m2. MEASUREMENTS: Logistic regression models, adjusted for demographics, physical characteristics, comorbid conditions, and medication use. RESULTS: Mean age was 52.2±11.9 (SD) years, 37% of participants were men; mean baseline eGFR was 87.3±17.3mL/min/1.73m2. The primary and secondary outcomes occurred in 148 (6.1%) and 162 (7.1%) participants, respectively. In unadjusted models, every 25-g greater LVM was significantly associated with greater odds of eGFR decline > 30% or ESRD (OR, 1.38; 95% CI, 1.26-1.51) and incident eGFR<60mL/min/1.73m2 or ESRD (OR, 1.30; 95% CI, 1.20-1.42); only the former remained statistically significant after adjustment. There was no association of LVEF or PASP with either eGFR decline > 30% or ESRD (LVEF: adjusted OR, 0.95 [95% CI, 0.84-1.07]; PASP: adjusted OR, 0.98 [95% CI, 0.87-1.11]) or incident eGFR<60mL/min/1.73m2 or ESRD (LVEF: adjusted OR, 0.98 [95% CI, 0.86-1.11]; PASP: adjusted OR, 1.05 [95% CI, 0.94-1.18]) in multivariable models. LIMITATIONS: No midstudy creatinine measurement at examination 2. CONCLUSIONS: Greater LVM was significantly associated with eGFR decline > 30% or ESRD among African Americans in a community-based cohort. Treating and reversing elevated LVM may reduce the burden and progression of kidney disease in this high-risk population. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/28143672/Echocardiographic_Measures_and_Estimated_GFR_Decline_Among_African_Americans:_The_Jackson_Heart_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(17)30003-3 DB - PRIME DP - Unbound Medicine ER -