Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 812 Kaohsiung, Taiwan.
Int J Med Sci. 2013;10(5):575-84. doi: 10.7150/ijms.5845. Epub 2013 Mar 16.
Echocardiographic left atrial diameter (LAD) has been documented to be an independent predictor of adverse cardiovascular outcomes in various populations. An enlarged left atrium is frequently noted in chronic kidney disease (CKD). We examined the association between albumin and indexed LAD (indexed to height) and assessed whether the combination of indexed LAD and albumin was independently associated with renal outcomes in patients with CKD stages 3-5.
This longitudinal study enrolled 395 patients, who were classified into four groups according to median values of indexed LAD (LAD/height) and albumin. The change in renal function was measured by estimated glomerular filtration rate (eGFR) slope. Rapid renal progression was defined as eGFR slope less than -3 ml/min/1.73 m(2)/year. The renal end point was defined as commencement of dialysis.
Albumin was significantly associated with indexed LAD (β = -0.108, P = 0.024). During follow-up period, seventy-four patients started dialysis. After the multivariate analysis, the group with higher indexed LAD and lower albumin was independently associated with rapid renal progression (odds ratio, 7.979; 95% confidence interval [CI], 3.028 to 21.025) and progression to dialysis (hazard ratio, 2.352; 95% CI, 1.078 to 5.131).
Our findings show that albumin is independently associated with indexed LAD and suggest that the combination of increased indexed LAD and hypoalbuminemia is independently associated with rapid renal progression and progression to dialysis in patients with CKD. Assessments of serum albumin and indexed LAD by echocardiography are useful for predicting the risk for adverse renal outcomes.
超声心动图左心房直径（LAD）已被证明是各种人群不良心血管结局的独立预测因子。左心房增大在慢性肾脏病（CKD）中经常被发现。我们研究了白蛋白与指数化 LAD（与身高相比）之间的关系，并评估了 CKD 3-5 期患者中指数化 LAD 和白蛋白的组合是否与肾脏结局独立相关。
这项纵向研究纳入了 395 名患者，根据指数化 LAD（LAD/身高）和白蛋白的中位数将其分为四组。肾功能变化通过估算肾小球滤过率（eGFR）斜率来测量。快速肾功能进展定义为 eGFR 斜率小于-3 ml/min/1.73 m(2)/年。肾脏终点定义为开始透析。
白蛋白与指数化 LAD 显著相关（β=-0.108，P=0.024）。在随访期间，74 名患者开始透析。经过多变量分析，具有较高指数化 LAD 和较低白蛋白的组与快速肾功能进展（优势比，7.979；95%置信区间[CI]，3.028 至 21.025）和进展为透析（风险比，2.352；95%CI，1.078 至 5.131）独立相关。
我们的研究结果表明，白蛋白与指数化 LAD 独立相关，表明增加的指数化 LAD 和低白蛋白血症的组合与 CKD 患者的快速肾功能进展和进展为透析独立相关。超声心动图评估血清白蛋白和指数化 LAD 有助于预测不良肾脏结局的风险。
