#5596 MODERATE AND SEVERE KIDNEY DYSFUNCTION ASSOCIATED WITH LEFT VENTRICLE DIASTOLIC DYSFUNCTION: A COHORT WITH DATA FROM ELECTRONIC HEALTHCARE RECORDS

Abstract

Abstract Background and Aims Left ventricular diastolic dysfunction is observed in patients with chronic kidney disease (CKD) and may lead to heart failure with preserved ejection fraction (HFpEF). In this study, we investigate the association between kidney dysfunction and left ventricular diastolic dysfunction (LVDD) in a cohort using data from electronic healthcare records. Method We utilized electronic healthcare data from the Utrecht Patient Oriented Database (UPOD), including all patients treated at University Medical Center Utrecht (UMCU), a university teaching hospital. We extracted demographic patient data, admission data, medication orders, and laboratory results. All performed echocardiography from baseline (i.e., first visit to the hospital) to end of follow-up (i.e., death or censoring) were included. The estimated glomerular filtration rate (eGFR) was calculated using the creatinine formula without ethnicity. Participants were divided into four groups depending on their eGFR (mL/min/1.73 m2) as follows: normal kidney function (eGFR ≥ 90), mild kidney dysfunction (eGFR ≥ 60–89), moderate kidney dysfunction (eGFR ≥ 30–59), and severe kidney dysfunction (eGFR < 30). The association of eGFR with E/A and E/e’ ratio was tested by multivariable adjusted cox proportional hazards survival analysis, reporting hazard ratios (HR) and 95% confidence intervals (CI). Results We identified 6,216 participants who received echocardiography as part of their routine care between 2012 and 2022. The mean age was 66.9 (SD: 12.04 years), and 41.7% of individuals were females. In total, 90.4% and 24.5% of the patients had, respectively, hypertension and diabetes. Twenty-six per cent of participants had normal kidney function, 48.2% had mild kidney dysfunction, and 21.3% and 4% had moderate and severe kidney dysfunction, respectively. In total, 16,935 echocardiography were performed. The median time from the first to the final echocardiography was 0.78 (IQR: 2.89 years). Adjusted multivariable analysis showed that patients with moderate (HR: 1.19; 95% CI: 1.09, 1.31) and severe kidney dysfunction (HR: 1.36; 95% CI: 1.14, 1.62) had higher probabilities of having E/A ratio <0.75 or >1.8 compared with those with normal kidney function. Similarly, for an E/e’ ratio >14, participants with moderate and severe kidney dysfunction had higher probabilities, HR: 1.62 (95% CI: 1.49, 1.77) and 2.10 (95% CI: 1.83, 2.42), respectively, compared with participants with normal kidney function. Conclusion Moderate and severe kidney dysfunction are independently associated with LVDD. This association is independent of sex, age, hypertension, and diabetes status and is stronger for severe kidney dysfunction. Early recognition of LVDD in kidney dysfunction might help identify those at highest risk of developing HFpEF.