Division of Nephrology, University of California, 521 Parnassus Avenue, San Francisco, CA 94143, USA. .
J Am Soc Nephrol. 2012 Oct;23(10):1725-34. doi: 10.1681/ASN.2012020145. Epub 2012 Aug 30.
Heart failure is a common consequence of CKD, and it portends high risk for mortality. However, among patients without known heart failure, the associations of different stages of estimated GFR (eGFR) with changes in cardiac structure and function are not well described. Here, we performed a cross-sectional analysis to study these associations among 3487 participants of the Chronic Renal Insufficiency Cohort Study. We estimated GFR using cystatin C. The prevalence of left ventricular hypertrophy (LVH) assessed by echocardiography was 32%, 48%, 57%, and 75% for eGFR categories ≥60, 45-59, 30-44, and <30 ml/min per 1.73 m(2), respectively. In fully adjusted multivariable analyses, subjects with eGFR levels of <30 ml/min per 1.73 m(2) had twofold higher odds of LVH (OR=2.20, 95% CI=1.40-3.40; P<0.001) relative to subjects with eGFR≥60 ml/min per 1.73 m(2). This reduction in kidney function also significantly associated with abnormal LV geometry but not diastolic or systolic dysfunction. An eGFR of 30-44 ml/min per 1.73 m(2) also significantly associated with LVH and abnormal LV geometry compared with eGFR≥60 ml/min per 1.73 m(2). In summary, in this large CKD cohort, reduced kidney function associated with abnormal cardiac structure. We did not detect significant associations between kidney function and systolic or diastolic function after adjusting for potential confounding variables.
心力衰竭是 CKD 的常见后果，预示着死亡率高。然而，在没有已知心力衰竭的患者中，不同阶段估计肾小球滤过率（eGFR）与心脏结构和功能变化的关系尚未得到很好的描述。在这里，我们对慢性肾功能不全队列研究的 3487 名参与者进行了横断面分析，以研究这些关联。我们使用胱抑素 C 估计肾小球滤过率。通过超声心动图评估的左心室肥厚（LVH）的患病率分别为 eGFR 类别≥60、45-59、30-44 和<30 ml/min/1.73 m2 的 32%、48%、57%和 75%。在完全调整的多变量分析中，eGFR 水平<30 ml/min/1.73 m2 的患者发生 LVH 的几率是 eGFR≥60 ml/min/1.73 m2 的患者的两倍（OR=2.20，95%CI=1.40-3.40；P<0.001）。肾功能的这种下降也与异常 LV 几何形状显著相关，但与舒张或收缩功能障碍无关。与 eGFR≥60 ml/min/1.73 m2 相比，eGFR 为 30-44 ml/min/1.73 m2 也与 LVH 和异常 LV 几何形状显著相关。总之，在这个大型 CKD 队列中，肾功能降低与心脏结构异常相关。在调整潜在混杂变量后，我们没有检测到肾功能与收缩或舒张功能之间存在显著关联。
