Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou First Road, Kaohsiung 807, Taiwan.
Clin J Am Soc Nephrol. 2011 Dec;6(12):2750-8. doi: 10.2215/CJN.04660511. Epub 2011 Oct 6.
Cardiac abnormalities were frequently noted in patients with chronic kidney disease (CKD). This study is designed to assess whether echocardiographic parameters are associated with rate of renal function decline and progression to dialysis in CKD stage 3 to 5 patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This longitudinal study enrolled 415 patients. The renal end point was defined as commencement of dialysis. The change in renal function was measured by estimated GFR (eGFR) slope.
Progression to dialysis was predicted by wide pulse pressure, low albumin, low hemoglobin, high calcium-phosphorous product, proteinuria, diuretics use, and concentric left ventricular hypertrophy (LVH) (hazard ratio, 2.03; 95% confidence interval [CI], 1.00 to 4.10; P = 0.05). The eGFR slope was negatively associated with total cholesterol, uric acid, proteinuria, diuretics use, and left atrial (LA) diameter (change in slope, -0.50; 95% CI, -0.89 to -0.11; P = 0.01) and positively associated with albumin and left ventricular ejection fraction (LVEF) (change in slope, 0.06; 95% CI, 0.03 to 0.08; P < 0.001).
Our study in patients of CKD stage 3 to 5 demonstrated that concentric LVH was associated with progression to dialysis, and that increased LA diameter and decreased LVEF were associated with faster renal function decline. Echocardiography may help identify high-risk groups with progressive decline in renal function to dialysis and rapid progression of renal dysfunction in CKD stage 3 to 5 patients.
慢性肾脏病（CKD）患者常伴有心脏异常。本研究旨在评估超声心动图参数与 CKD 3 至 5 期患者肾功能下降速度和进展至透析的关系。
设计、地点、参与者和测量：这项纵向研究纳入了 415 例患者。肾脏终点定义为开始透析。肾功能变化通过估算肾小球滤过率（eGFR）斜率来衡量。
宽脉压、低白蛋白、低血红蛋白、高钙磷乘积、蛋白尿、利尿剂使用和向心性左心室肥厚（LVH）预测了进展至透析（危险比，2.03；95%置信区间[CI]，1.00 至 4.10；P = 0.05）。eGFR 斜率与总胆固醇、尿酸、蛋白尿、利尿剂使用和左心房（LA）直径呈负相关（斜率变化，-0.50；95%CI，-0.89 至-0.11；P = 0.01），与白蛋白和左心室射血分数（LVEF）呈正相关（斜率变化，0.06；95%CI，0.03 至 0.08；P < 0.001）。
我们对 CKD 3 至 5 期患者的研究表明，向心性 LVH 与进展至透析相关，而 LA 直径增加和 LVEF 降低与肾功能下降速度加快相关。超声心动图可能有助于识别肾功能进行性下降至透析和 CKD 3 至 5 期患者肾功能快速恶化的高危人群。
