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)
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 (eGFRcysC) 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 eGFRcysC was 94 ± 32 mL/min/1.73 m2. LVH was distinctly more prevalent (>12%) in only the lowest 2 deciles of eGFRcysC (<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 eGFRcysC less than 75 mL/min/1.73 m2: odds ratio 1.6 for LVH with eGFRcysC 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 eGFRcysC 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 eGFRcysC 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.
Conclusions
In participants without chronic kidney disease, eGFRcysC of 75 mL/min/1.73 m2 or less was associated with a greater odds of LVH.
1Division of General Internal Medicine, Department of Medicine, Columbia University, New York, NY
2Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA
3Department of Pathology, University of Vermont, Colchester, VT
4Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
5Department of Radiology, Johns Hopkins University, Baltimore, MD
6Department of Cardiology, Johns Hopkins University, Baltimore, MD
7Department of Epidemiology, University of Washington, Seattle, WA
8Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
9Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
10General 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
A list of author affiliations appears at the end of this article.
ABSTRACT