Left Ventricular Hypertrophy in Mild and Moderate Reduction in Kidney Function Determined Using Cardiac Magnetic Resonance Imaging and Cystatin C: The Multi-Ethnic Study of Atherosclerosis (MESA)

Moran, Andrew; Katz, Ronit; Jenny, Nancy Swords; Astor, Brad; Bluemke, David A.; Lima, João A.C.; Siscovick, David; Bertoni, Alain G.; Shlipak, Michael G.

doi:10.1053/j.ajkd.2008.06.012

« Previous Next »American Journal of Kidney Diseases
Volume 52, Issue 5 , Pages 839-848, November 2008

Left Ventricular Hypertrophy in Mild and Moderate Reduction in Kidney Function Determined Using Cardiac Magnetic Resonance Imaging and Cystatin C: The Multi-Ethnic Study of Atherosclerosis (MESA)

Andrew Moran, MD, MPH
- Division of General Internal Medicine, Department of Medicine, Columbia University, New York, NY
Ronit Katz, DPhil
- Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA
Nancy Swords Jenny, PhD
- Department of Pathology, University of Vermont, Colchester, VT
Brad Astor, PhD, MPH
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
David A. Bluemke, MD, PhD
- Department of Radiology, Johns Hopkins University, Baltimore, MD
João A.C. Lima, MD
- Department of Cardiology, Johns Hopkins University, Baltimore, MD
David Siscovick, MD, MPH
- Department of Epidemiology, University of Washington, Seattle, WA
Alain G. Bertoni, MD
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
Michael G. Shlipak, MD, MPH
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
- General Internal Medicine Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA
- Address correspondence to Michael G. Shlipak, MD, MPH, Chief, General Internal Medicine Section, VA Medical Center (111A1), 4150 Clement St, San Francisco, CA 94121

Received 7 February 2008; accepted 4 June 2008. published online 09 October 2008.

Background

Left ventricular (LV) hypertrophy (LVH) is associated with chronic kidney disease, but the association of LVH with a mild decrease in kidney function is not known. We hypothesized that mild and moderate decreases in kidney function, reflected in greater serum cystatin C concentrations, would be linearly associated with a greater prevalence of LVH.

Study Design

Cross-sectional observational study.

Settings & Participants

Participants in baseline examinations in the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based study with several sites in the United States.

Predictors

Cystatin C–based estimated glomerular filtration rate (eGFR_cysC) and creatinine-based eGFR.

Outcomes

LVH and LV mass index.

Measurements

Serum cystatin C and creatinine, LV mass obtained by using magnetic resonance imaging. LVH cutoff values for men and women were defined by the upper 95th percentile of LV mass index of all MESA participants without hypertension.

Results

Of the 4,971 participants analyzed, mean creatinine-based eGFR was 81 ± 17 (SD) mL/min/1.73 m² and mean eGFR_cysC was 94 ± 32 mL/min/1.73 m². LVH was distinctly more prevalent (>12%) in only the lowest 2 deciles of eGFR_cysC (<75 mL/min/1.73 m²). When 435 participants (9%) with stage 3 or higher chronic kidney disease (creatinine-based eGFR < 60 mL/min/1.73 m²) were excluded, the odds for LVH increased for each lower category of eGFR_cysC less than 75 mL/min/1.73 m²: odds ratio 1.6 for LVH with eGFR_cysC of 60 to 75 mL/min/1.73 m² (95% confidence interval, 1.20 to 2.07; P = 0.001), and odds ratio 2.0 for eGFR_cysC less than 60 mL/min/1.73 m² (95% confidence interval, 1.03 to 3.75; P = 0.04) after adjustment for demographic factors, study site, diabetes, and smoking. The association of lower eGFR_cysC with LVH was attenuated after further adjustment for hypertension.

Limitations

Cross-sectional rather than longitudinal design, lack of participants with more advanced kidney disease, lack of a direct measurement of glomerular filtration rate.