Abstract P195: Title

Abstract

Background: A bidirectional relationship between cardiovascular disease and chronic kidney disease (CKD) is well-recognized, but the association of cardiac dysfunction and structure with the risk of CKD progression has not been systematically evaluated in a CKD population. Methods: We analyzed Chronic Renal Insufficiency Cohort participants who underwent an echocardiogram at baseline. We evaluated the association of left ventricular mass index (LVMI), left ventricular ejection fraction (EF), left atrial area (LAA), and peak tricuspid regurgitation (TR) velocity with CKD progression, defined as ≥50% decline in estimated glomerular filtration rate (eGFR) or incident end-stage kidney disease. A secondary outcome was annual eGFR slope. We used multivariable Cox models and mixed-effects models for these outcomes, respectively. Results: Among 3,025 eligible patients, mean age was 59 (SD 11) years, 54% were men, 46% had diabetes, and mean eGFR was 43 (17) ml/min/1.73m 2 . Higher LVMI, LAA, peak TR velocity, and lower EF were each significantly associated with an increased risk of CKD progression. Corresponding HRs for the highest vs. lowest quartiles [lowest vs. highest for EF] were 2.38 (95% CI, 1.87-3.03), 1.51 (1.21-1.88), 1.57 (1.20-2.06), and 1.22 (1.02-1.47) (Table). Participants in the highest quartile (vs. lowest quartile) of LVMI and peak TR velocity had a significantly faster eGFR decline (i.e., ΔeGFR slope per year, -0.33 [95% CI, -0.43 to -0.22] and -0.33 [-0.46 to -0.20] ml/min/1.73m 2 , respectively) (Table). In contrast, EF and LAA were not associated with eGFR slopes (p for linear trend >0.05). Conclusions: While echo-based parameters of cardiac structure and function were generally associated with increased risk of CKD progression, only higher LVMI and peak TR velocity were independently associated with faster eGFR decline in slope analyses. Our findings may indicate different mechanisms associated with adverse kidney outcomes based on cardiac structural and functional phenotypes.