Abstract 11706: Association of Left Atrial Function With Incident Chronic Kidney Disease: Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Introduction: Echocardiographic measures of left ventricular (LV) structure and function are associated with incident chronic kidney disease (CKD). Reduced left atrial (LA) function is an emerging novel risk factor for cardiovascular disease but its association with incident CKD is unknown. Hypothesis: Lower LA function is independently associated with incident CKD in older adults in the ARIC study, a prospective community-based cohort. Methods: We included ARIC participants without prevalent CKD (as defined by eGFR<60ml/min/1.73m 2 ) who underwent echocardiographic exam at visit 5 (2011-13). LA function measures included LA reservoir strain, contractile strain, and conduit strain. Incident CKD was defined as a composite outcome of >25% decline to eGFR <60 mL/min/1.73m 2 , hospitalization with CKD diagnosis, or incident end-stage kidney disease through 2017. Cox proportional hazards model was used. Results: Among the 3,970 participants (mean [SD] age, 75 [5] years; 58% women; 20.9% Black individuals), 382 cases of incident CKD were ascertained over a median follow-up of 5.5 years. Lower LA reservoir and contractile strain were significantly associated with higher risk of CKD (HR [95% CI] lowest vs highest quintile: 2.76 [1.91-3.98], and 2.56 [1.79-3.65], respectively) (Table). The associations remained significant after accounting for other major echocardiographic parameters (model 2) including left atrial volume index (model 3). LA conduit strain was not significantly associated with CKD. Conclusions: Lower LA function is significantly associated with incident CKD, independent of CKD risk factors, LV size and function, and LA size. These findings indicate that impaired LA function is a novel predictor marker for CKD.