Prognostic Significance of Left Ventricular Mass Index and Renal Function Decline Rate in Chronic Kidney Disease G3 and G4

Jiun-Chi Huang,Hung-Chun Chen,Shang-Jyh Hwang,Szu-Chia Chen,I-Ching Kuo,Yi-Chun Tsai,Jer-Ming Chang,Yi-Wen Chiu

doi:10.1038/srep42578

Abstract

The effect of left ventricular mass index (LVMI) and estimated glomerular filtration rate (eGFR) decline rate on outcome prediction in patients with chronic kidney disease (CKD) remains unclear. We included 306 CKD G3 and G4 patients with LVMI assessed through echocardiography. Rapid decline in renal function was defined as the eGFR slope <−3 mL/min/1.73 m2/year. Patients were stratified into four groups using sex-specific median values of LVMI and rapid eGFR decline. The composite outcome was progression to maintenance dialysis or death. 32 patients had the composite outcome during a median follow-up of 2.7 years. In multivariate Cox analysis, compared with patients with non-rapid eGFR decline and lower LVMI, those with non-rapid eGFR decline and higher LVMI (hazard ratio [HR]: 5.908, 95% confidence interval [CI] = 1.304–26.780), rapid eGFR decline and lower LVMI (HR: 12.737, 95% CI = 2.297–70.636), and rapid eGFR decline and higher LVMI (HR: 15.249, 95% CI = 3.365–69.097) had an increased risk of progression to adverse outcomes. LVMI and eGFR decline synergistically effect the prognostic implications in CKD G3 and G4 patients.

Highlights

chronic kidney disease (CKD) considerably increases the risk of CVD
On the basis of the decline rate in renal function and sex-specific median value of the left ventricular mass index (LVMI), 306 patients with CKD G3 and G4 were stratified into four groups
This study investigated the effect of the interaction between the LVMI and renal function decline rate on the adverse outcomes in patients with CKD G3–4 over an observation period of 2.7 years

Summary

Introduction

CKD considerably increases the risk of CVD. Given that CKD and CVD share many of the same risk factors, abnormal cardiac structure and function is one of principal predictors of adverse clinical outcomes[9]. Left ventricular hypertrophy (LVH) is highly prevalent in CKD patients and is associated with the risk of mortality and unfavorable prognosis[10,11,12]. CKD patients have progressively increasing left ventricular (LV) mass with decreased renal function[10]. The effect of the interaction between the LVMI and eGFR decline rate on the prediction of the renal outcomes in patients with CKD remains unclear. The present study investigates whether the combination of the LVMI and eGFR decline rate is associated with the composite outcome of disease progression to maintenance dialysis or death in CKD G3 and G4 patients

Methods

Results

Conclusion