Advertisement
American Journal of Kidney Diseases

Estimated GFR and Subsequent Higher Left Ventricular Mass in Young and Middle-Aged Adults With Normal Kidney Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Published:August 04, 2015DOI:https://doi.org/10.1053/j.ajkd.2015.06.024

      Background

      Left ventricular hypertrophy is common and is associated with cardiovascular events and death among patients with known chronic kidney disease. However, the link between reduced glomerular filtration rate (GFR) and left ventricular mass index (LVMI) remains poorly explored among young and middle-aged adults with preserved kidney function. In this study, we examined the association of cystatin C–based estimated GFR (eGFRcys) and rapid decline in eGFR with subsequent LVMI.

      Study Design

      Observational study.

      Setting & Participants

      We included 2,410 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort with eGFRcys > 60 mL/min/1.73 m2 at year 15 and who had an echocardiogram obtained at year 25.

      Predictor

      eGFRcys at year 15 and rapid decline in eGFRcys (defined as >3% per year over 5 years from years 15 to 20).

      Outcome

      LVMI measured at year 25.

      Measurements

      We adjusted for age, sex, race, diabetes, body mass index, low- and high-density lipoprotein cholesterol levels, cumulative systolic blood pressure, and albuminuria.

      Results

      Mean age was 40 ± 4 (SD) years, 58% were women, and 43% were black. After 10 years of follow-up, mean LVMI was 39.6 ± 13.4 g/m2.7. Compared with eGFRcys > 90 mL/min/1.73 m2 (n = 2,228), eGFRcys of 60 to 75 mL/min/1.73 m2 (n = 29) was associated with 5.63 (95% CI, 0.90-10.36) g/m2.7 greater LVMI (P = 0.02), but there was no association of eGFRcys of 76 to 90 mL/min/1.73 m2 (n = 153) with LVMI after adjustment for confounders. Rapid decline in eGFRcys was associated with higher LVMI compared with participants without a rapid eGFRcys decline (β coefficient, 1.48; 95% CI, 0.11-2.83; P = 0.03) after adjustment for confounders.

      Limitations

      There were a limited number of participants with eGFRcys of 60 to 90 mL/min/1.73 m2.

      Conclusions

      Among young and middle-aged adults with preserved kidney function, eGFRcys of 60 to 75 mL/min/1.73 m2 and rapid decline in eGFRcys were significantly associated with subsequently higher LVMI. Further studies are needed to understand the mechanisms that contribute to elevated LVMI in this range of eGFRcys.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Go A.S.
        • Chertow G.M.
        • Fan D.
        • McCulloch C.E.
        • Hsu C.Y.
        Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.
        N Engl J Med. 2004; 351: 1296-1305
        • Foley R.N.
        • Murray A.M.
        • Li S.
        • et al.
        Chronic kidney disease and the risk for cardiovascular disease, renal replacement, and death in the United States Medicare population, 1998 to 1999.
        J Am Soc Nephrol. 2005; 16: 489-495
        • Eckardt K.U.
        • Scherhag A.
        • Macdougall I.C.
        • et al.
        Left ventricular geometry predicts cardiovascular outcomes associated with anemia correction in CKD.
        J Am Soc Nephrol. 2009; 20: 2651-2660
        • Levin A.
        • Thompson C.R.
        • Ethier J.
        • et al.
        Left ventricular mass index increase in early renal disease: impact of decline in hemoglobin.
        Am J Kidney Dis. 1999; 34: 125-134
        • Paoletti E.
        • Bellino D.
        • Cassottana P.
        • Rolla D.
        • Cannella G.
        Left ventricular hypertrophy in nondiabetic predialysis CKD.
        Am J Kidney Dis. 2005; 46: 320-327
        • Levin A.
        • Singer J.
        • Thompson C.R.
        • Ross H.
        • Lewis M.
        Prevalent left ventricular hypertrophy in the predialysis population: identifying opportunities for intervention.
        Am J Kidney Dis. 1996; 27: 347-354
        • Park M.
        • Hsu C.Y.
        • Li Y.
        • et al.
        Associations between kidney function and subclinical cardiac abnormalities in CKD.
        J Am Soc Nephrol. 2012; 23: 1725-1734
        • Faul C.
        • Amaral A.P.
        • Oskouei B.
        • et al.
        FGF23 induces left ventricular hypertrophy.
        J Clin Invest. 2011; 121: 4393-4408
        • Friedman G.D.
        • Cutter G.R.
        • Donahue R.P.
        • et al.
        CARDIA: study design, recruitment, and some characteristics of the examined subjects.
        J Clin Epidemiol. 1988; 41: 1105-1116
        • Hojs R.
        • Bevc S.
        • Ekart R.
        • Gorenjak M.
        • Puklavec L.
        Serum cystatin C as an endogenous marker of renal function in patients with mild to moderate impairment of kidney function.
        Nephrol Dial Transplant. 2006; 21: 1855-1862
        • Shlipak M.G.
        • Katz R.
        • Sarnak M.J.
        • et al.
        Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease.
        Ann Intern Med. 2006; 145: 237-246
        • White C.
        • Akbari A.
        • Hussain N.
        • et al.
        Estimating glomerular filtration rate in kidney transplantation: a comparison between serum creatinine and cystatin C-based methods.
        J Am Soc Nephrol. 2005; 16: 3763-3770
        • Inker L.A.
        • Schmid C.H.
        • Tighiouart H.
        • et al.
        Estimating glomerular filtration rate from serum creatinine and cystatin C.
        N Engl J Med. 2012; 367: 20-29
        • Herget-Rosenthal S.
        • Pietruck F.
        • Volbracht L.
        • Philipp T.
        • Kribben A.
        Serum cystatin C—a superior marker of rapidly reduced glomerular filtration after uninephrectomy in kidney donors compared to creatinine.
        Clin Nephrol. 2005; 64: 41-46
        • Bansal N.
        • Vittinghoff E.
        • Peralta C.A.
        • et al.
        Estimated kidney function based on serum cystatin C and risk of subsequent coronary artery calcium in young and middle-aged adults with preserved kidney function: results from the CARDIA Study.
        Am J Epidemiol. 2013; 178: 410-417
        • Peralta C.A.
        • Vittinghoff E.
        • Bansal N.
        • et al.
        Trajectories of kidney function decline in young black and white adults with preserved GFR: results from the Coronary Artery Risk Development in Young Adults (CARDIA) Study.
        Am J Kidney Dis. 2013; 62: 261-266
        • Grubbs V.
        • Lin F.
        • Vittinghoff E.
        • et al.
        Body mass index and early kidney function decline in young adults: a longitudinal analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) Study.
        Am J Kidney Dis. 2014; 63: 590-597
        • Inker L.A.
        • Eckfeldt J.
        • Levey A.S.
        • et al.
        Expressing the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) cystatin C equations for estimating GFR with standardized serum cystatin C values.
        Am J Kidney Dis. 2011; 58: 682-684
        • Grubb A.
        • Blirup-Jensen S.
        • Lindstrom V.
        • et al.
        First certified reference material for cystatin C in human serum ERM-DA471/IFCC.
        Clin Chem Lab Med. 2010; 48: 1619-1621
        • Blirup-Jensen S.
        • Grubb A.
        • Lindstrom V.
        • Schmidt C.
        • Althaus H.
        Standardization of cystatin C: development of primary and secondary reference preparations.
        Scand J Clin Lab Invest Suppl. 2008; 241: 67-70
        • Rifkin D.E.
        • Shlipak M.G.
        • Katz R.
        • et al.
        Rapid kidney function decline and mortality risk in older adults.
        Arch Intern Med. 2008; 168: 2212-2218
        • Shlipak M.G.
        • Katz R.
        • Kestenbaum B.
        • Fried L.F.
        • Siscovick D.
        • Sarnak M.J.
        Clinical and subclinical cardiovascular disease and kidney function decline in the elderly.
        Atherosclerosis. 2009; 204: 298-303
        • Shlipak M.G.
        • Katz R.
        • Kestenbaum B.
        • et al.
        Rapid decline of kidney function increases cardiovascular risk in the elderly.
        J Am Soc Nephrol. 2009; 20: 2625-2630
        • Gardin J.M.
        • Wagenknecht L.E.
        • Anton-Culver H.
        • et al.
        Relationship of cardiovascular risk factors to echocardiographic left ventricular mass in healthy young black and white adult men and women. The CARDIA Study. Coronary Artery Risk Development in Young Adults.
        Circulation. 1995; 92: 380-387
        • Kishi S.
        • Armstrong A.C.
        • Gidding S.S.
        • et al.
        Relation of left ventricular mass at age 23 to 35 years to global left ventricular systolic function 20 years later (from the Coronary Artery Risk Development in Young Adults Study).
        Am J Cardiol. 2014; 113: 377-383
        • Devereux R.B.
        • Alonso D.R.
        • Lutas E.M.
        • et al.
        Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.
        Am J Cardiol. 1986; 57: 450-458
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • et al.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Loria C.M.
        • Liu K.
        • Lewis C.E.
        • et al.
        Early adult risk factor levels and subsequent coronary artery calcification: the CARDIA Study.
        J Am Coll Cardiol. 2007; 49: 2013-2020
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Pletcher M.J.
        • Bibbins-Domingo K.
        • Lewis C.E.
        • et al.
        Prehypertension during young adulthood and coronary calcium later in life.
        Ann Intern Med. 2008; 149: 91-99
        • Murtaugh M.A.
        • Jacobs Jr., D.R.
        • Yu X.
        • Gross M.D.
        • Steffes M.
        Correlates of urinary albumin excretion in young adult blacks and whites: the Coronary Artery Risk Development in Young Adults Study.
        Am J Epidemiol. 2003; 158: 676-686
        • Jacobs Jr., D.R.
        • Murtaugh M.A.
        • Steffes M.
        • Yu X.
        • Roseman J.
        • Goetz F.C.
        Gender- and race-specific determination of albumin excretion rate using albumin-to-creatinine ratio in single, untimed urine specimens: the Coronary Artery Risk Development in Young Adults Study.
        Am J Epidemiol. 2002; 155: 1114-1119
        • Shlipak M.G.
        • Matsushita K.
        • Arnlov J.
        • et al.
        Cystatin C versus creatinine in determining risk based on kidney function.
        N Engl J Med. 2013; 369: 932-943
        • Moran A.
        • Katz R.
        • Jenny N.S.
        • et al.
        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).
        Am J Kidney Dis. 2008; 52: 839-848
        • Sarnak M.J.
        Cardiovascular complications in chronic kidney disease.
        Am J Kidney Dis. 2003; 41: 11-17
        • Isakova T.
        • Wahl P.
        • Vargas G.S.
        • et al.
        Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease.
        Kidney Int. 2011; 79: 1370-1378
        • Yamamoto K.T.
        • Robinson-Cohen C.
        • de Oliveira M.C.
        • et al.
        Dietary phosphorus is associated with greater left ventricular mass.
        Kidney Int. 2013; 83: 707-714
        • Assalin H.B.
        • Rafacho B.P.
        • dos Santos P.P.
        • et al.
        Impact of the length of vitamin D deficiency on cardiac remodeling.
        Circ Heart Fail. 2013; 6: 809-816
        • Gutierrez O.M.
        • Januzzi J.L.
        • Isakova T.
        • et al.
        Fibroblast growth factor 23 and left ventricular hypertrophy in chronic kidney disease.
        Circulation. 2009; 119: 2545-2552
        • van Ballegooijen A.J.
        • Visser M.
        • Cotch M.F.
        • et al.
        Serum vitamin D and parathyroid hormone in relation to cardiac structure and function: the ICELAND-MI substudy of AGES-Reykjavik.
        J Clin Endocrinol Metab. 2013; 98: 2544-2552
        • van Ballegooijen A.J.
        • Visser M.
        • Kestenbaum B.
        • et al.
        Relation of vitamin D and parathyroid hormone to cardiac biomarkers and to left ventricular mass (from the Cardiovascular Health Study).
        Am J Cardiol. 2013; 111: 418-424
        • Glasser S.P.
        • Lynch A.I.
        • Devereux R.B.
        • Hopkins P.
        • Arnett D.K.
        Hemodynamic and echocardiographic profiles in African American compared with white offspring of hypertensive parents: the HyperGEN Study.
        Am J Hypertens. 2014; 27: 21-26
        • Natori S.
        • Lai S.
        • Finn J.P.
        • et al.
        Cardiovascular function in Multi-Ethnic Study of Atherosclerosis: normal values by age, sex, and ethnicity.
        AJR Am J Roentgenol. 2006; 186(6): S357-S365
        • Bibbins-Domingo K.
        • Pletcher M.J.
        • Lin F.
        • et al.
        Racial differences in incident heart failure among young adults.
        N Engl J Med. 2009; 360: 1179-1190
        • Shlipak M.G.
        • Sarnak M.J.
        • Katz R.
        • et al.
        Cystatin C and the risk of death and cardiovascular events among elderly persons.
        N Engl J Med. 2005; 352: 2049-2060
        • Bibbins-Domingo K.
        • Chertow G.M.
        • Fried L.F.
        • et al.
        Renal function and heart failure risk in older black and white individuals: the Health, Aging, and Body Composition Study.
        Arch Intern Med. 2006; 166: 1396-1402
        • Huang S.H.
        • Macnab J.J.
        • Sontrop J.M.
        • et al.
        Performance of the creatinine-based and the cystatin C-based glomerular filtration rate (GFR) estimating equations in a heterogenous sample of patients referred for nuclear GFR testing.
        Transl Res. 2011; 157: 357-367