Lower Estimated Glomerular Filtration Rate and Higher Left Ventricular Mass Index Is Associated With Adverse Clinical Outcomes in Chronic Kidney Disease Patients

Wen-Pin Lee ； Pei-Yu Wu ； Jiun-Chi Huang ； Szu-Chia Chen ； Yi-Wen Chiu ； Jer-Ming Chang ； Shang-Jyh Hwang ； Hung-Chun Chen

《Acta Nephrologica》 34卷1期 (2020/03) Pp. 24-33

https://doi.org/10.6221/AN.202003_34(1).0004

摘要

BACKGROUND: Left ventricular hypertrophy (LVH) is prevalent in chronic kidney disease (CKD), but the association of renal function and LVH with renal outcomes in patients with CKD is unclear. Therefore, our study investigates whether the combination of the left ventricular mass index (LVMI) and estimated glomerular filtration rate (eGFR) is associated with the clinical outcomes, including eGFR slope, progression to dialysis, and overall mortality in patients with CKD stages 3-5. METHODS: We consecutively enrolled 419 CKD patients from our outpatient department of internal medicine from May 2006 to January 2010, who were classified into four groups according to the median value of eGFR and the sex-specific median value of LVMI. The rate of renal function decline was assessed by the eGFR slope. Rapid renal progression was defined as eGFR slope ＜ -3 mL/min/1.73 m^2/year. RESULTS: The patients were stratified into four groups according to the median value of eGFR (26.0 mL/min/1.73 m^2) and the sex-specific median value of LVMI (male, 136.4; female, 131.6 g/m^2). The eGFR slopes in 4 groups were -0.66 ± 0.17, -1.56 ± 0.37, -2.19 ± 0.23, and -3.53 ± 0.32 mL/min/1.73 m^2/year, respectively. The eGFR slope was the lowest in the group with lower eGFR and higher LVMI than in other groups (P ≤ 0.007). After multivariable model adjusting for demographic, clinical and biochemical characteristics and medications, the group with lower eGFR and higher LVMI (vs. the group with higher eGFR and lower LVMI) was significantly associated with rapid renal progression (odds ratio, 3.115; 95% confidence interval [CI]: 1.156-8.394; P = 0.025), increased risk of progression to dialysis (hazards ratio [HR], 2.796; 95% CI, 1.494-5.232; P = 0.001) and overall mortality (HR, 5.369; 95% CI, 1.842-15.646; P = 0.002). CONCLUSION: The findings showed that the combination of low eGFR and high LVMI was associated with adverse renal outcomes and increased risk of overall mortality in patients with CKD stages 3-5.

關鍵字

chronic kidney disease ； dialysis ； estimated glomerular filtration rate ； left ventricular mass index ； overall mortality ； rapid renal progression