TY - JOUR
T1 - Evolution of Echocardiographic Measures of Cardiac Disease From CKD to ESRD and Risk of All-Cause Mortality
T2 - Findings From the CRIC Study
AU - CRIC Study Investigators
AU - Bansal, Nisha
AU - Roy, Jason
AU - Chen, Hsiang Yu
AU - Deo, Rajat
AU - Dobre, Mirela
AU - Fischer, Michael J.
AU - Foster, Elyse
AU - Go, Alan S.
AU - He, Jiang
AU - Keane, Martin G.
AU - Kusek, John W.
AU - Mohler, Emile
AU - Navaneethan, Sankar D.
AU - Rahman, Mahboob
AU - Hsu, Chi yuan
AU - Appel, Lawrence J.
AU - Feldman, Harold I.
AU - Go, Alan S.
AU - Kusek, John W.
AU - Lash, James P.
AU - Ojo, Akinlolu
AU - Rahman, Mahboob
AU - Townsend, Raymond R.
N1 - Publisher Copyright:
© 2018 National Kidney Foundation, Inc.
PY - 2018/9
Y1 - 2018/9
N2 - Rationale & Objective: Abnormal cardiac structure and function are common in chronic kidney disease (CKD) and end-stage renal disease (ESRD) and linked with mortality and heart failure. We examined changes in echocardiographic measures during the transition from CKD to ESRD and their associations with post-ESRD mortality. Study Design: Prospective study. Setting & Participants: We studied 417 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) who had research echocardiograms during CKD and ESRD. Predictor: We measured change in left ventricular mass index, left ventricular ejection fraction (LVEF), diastolic relaxation (normal, mildly abnormal, and moderately/severely abnormal), left ventricular end-systolic (LVESV), end-diastolic (LVEDV) volume, and left atrial volume from CKD to ESRD. Outcomes: All-cause mortality after dialysis therapy initiation. Analytical Approach: Cox proportional hazard models were used to test the association of change in each echocardiographic measure with postdialysis mortality. Results: Over a mean of 2.9 years between pre- and postdialysis echocardiograms, there was worsening of mean LVEF (52.5% to 48.6%; P < 0.001) and LVESV (18.6 to 20.2 mL/m2.7; P < 0.001). During this time, there was improvement in left ventricular mass index (60.4 to 58.4 g/m2.7; P = 0.005) and diastolic relaxation (11.11% to 4.94% with moderately/severely abnormal; P = 0.02). Changes in left atrial volume (4.09 to 4.15 mL/m2; P = 0.08) or LVEDV (38.6 to 38.4 mL/m2.7; P = 0.8) were not significant. Worsening from CKD to ESRD of LVEF (adjusted HR for every 1% decline in LVEF, 1.03; 95% CI, 1.00-1.06) and LVESV (adjusted HR for every 1 mL/m2.7 increase, 1.04; 95% CI, 1.02-1.07) were independently associated with greater risk for postdialysis mortality. Limitations: Some missing or technically inadequate echocardiograms. Conclusions: In a longitudinal study of patients with CKD who subsequently initiated dialysis therapy, LVEF and LVESV worsened and were significantly associated with greater risk for postdialysis mortality. There may be opportunities for intervention during this transition period to improve outcomes.
AB - Rationale & Objective: Abnormal cardiac structure and function are common in chronic kidney disease (CKD) and end-stage renal disease (ESRD) and linked with mortality and heart failure. We examined changes in echocardiographic measures during the transition from CKD to ESRD and their associations with post-ESRD mortality. Study Design: Prospective study. Setting & Participants: We studied 417 participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) who had research echocardiograms during CKD and ESRD. Predictor: We measured change in left ventricular mass index, left ventricular ejection fraction (LVEF), diastolic relaxation (normal, mildly abnormal, and moderately/severely abnormal), left ventricular end-systolic (LVESV), end-diastolic (LVEDV) volume, and left atrial volume from CKD to ESRD. Outcomes: All-cause mortality after dialysis therapy initiation. Analytical Approach: Cox proportional hazard models were used to test the association of change in each echocardiographic measure with postdialysis mortality. Results: Over a mean of 2.9 years between pre- and postdialysis echocardiograms, there was worsening of mean LVEF (52.5% to 48.6%; P < 0.001) and LVESV (18.6 to 20.2 mL/m2.7; P < 0.001). During this time, there was improvement in left ventricular mass index (60.4 to 58.4 g/m2.7; P = 0.005) and diastolic relaxation (11.11% to 4.94% with moderately/severely abnormal; P = 0.02). Changes in left atrial volume (4.09 to 4.15 mL/m2; P = 0.08) or LVEDV (38.6 to 38.4 mL/m2.7; P = 0.8) were not significant. Worsening from CKD to ESRD of LVEF (adjusted HR for every 1% decline in LVEF, 1.03; 95% CI, 1.00-1.06) and LVESV (adjusted HR for every 1 mL/m2.7 increase, 1.04; 95% CI, 1.02-1.07) were independently associated with greater risk for postdialysis mortality. Limitations: Some missing or technically inadequate echocardiograms. Conclusions: In a longitudinal study of patients with CKD who subsequently initiated dialysis therapy, LVEF and LVESV worsened and were significantly associated with greater risk for postdialysis mortality. There may be opportunities for intervention during this transition period to improve outcomes.
KW - all-cause mortality
KW - cardiac disease
KW - cardiovascular disease (CVD)
KW - CKD to ESRD transition
KW - dialysis
KW - dialysis initiation
KW - diastolic relaxation
KW - echocardiogram
KW - end-stage renal disease (ESRD)
KW - heart failure
KW - Kidney
KW - left atrial volume
KW - left ventricular ejection fraction (LVEF)
KW - left ventricular end-diastolic volume (LVEDV)
KW - left ventricular end-systolic volume (LVESV)
KW - left ventricular mass index (LVMI)
KW - subclinical CVD
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U2 - 10.1053/j.ajkd.2018.02.363
DO - 10.1053/j.ajkd.2018.02.363
M3 - Article
C2 - 29784617
AN - SCOPUS:85047180100
SN - 0272-6386
VL - 72
SP - 390
EP - 399
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -