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Dai L, Yang Y, Liu L, Long C, Da J, Chen S, Zhao J, Shen Y, Huang C, Zha Y, Yuan J. The association of left ventricular fraction shortening with cardiovascular events in peritoneal dialysis patients. Ren Fail 2023; 45:2261786. [PMID: 37779359 PMCID: PMC11001333 DOI: 10.1080/0886022x.2023.2261786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) patients have a high incidence of cardiovascular events (CVEs). Left ventricular fraction shortening (LVFS), one of the echocardiographic parameters, is an independent risk factor for mortality in previous studies. The aim of this study was to evaluate associations between LVFS and CVEs in PD patients. METHODS This was a single-center observational cohort study. Seven hundred and eighty-four PD patients were enrolled from 1 January 2012 to 1 June 2021 and followed until 1 June 2022. The primary outcome was the incidence of CVEs. PD patients were categorized into three groups according to the tertiles of LVFS levels (tertile 1-tertile 3). Kaplan-Meier method, Cox proportional hazard models and competing risk regression models were used for survival analysis. The areas under the curve (AUC) of receiver-operating characteristic analysis was used to determine the predictive values of LVFS for CVEs. A preplanned subgroup analysis was assessed according to age, gender, and the presence of hypertension and dyslipidemia, etc. RESULTS During a median follow-up period of 42.3 months (interquartile range 24.0-79.0 months), 259 CVEs occurred. Compared to the other two groups respectively, patients in tertile 3 group had the lowest incidence of CVEs (24.5% vs 31.6% vs 43.0%, respectively, p < 0.05). After multiple adjustments, the tertile 3 group was associated with the 45.1% decrease in the CVEs hazard compared to that of the tertile1 group (SHR = 0.549, 95%CI: 0.395-0.762, p < 0.001). Subgroup analysis demonstrated that tertile 1 group as the reference, the association between LVFS and CVEs in tertile 3 group was robust among female patients (HR = 0.506, 95%CI: 0.309-0.829, p = 0.007), aged < 45 years (HR = 0.496, 95%CI: 0.331-0.744, p = 0.001), history of hypertension (HR = 0.586, 95%CI: 0.349-0.872, p = 0.008) and combined with dyslipidemia (HR = 0.464, 95%CI: 0.269-0.799, p = 0.006). CONCLUSIONS This study suggests that LVFS is independently associated with the increased risk of CVEs in PD patients, especially those with aged < 45 years, female, with hypertension and dyslipidemia.
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Affiliation(s)
- Lu Dai
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Yuqi Yang
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Lu Liu
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Changzhu Long
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Jingjing Da
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Shuang Chen
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Jianqiu Zhao
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Yan Shen
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Chengchong Huang
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
| | - Jing Yuan
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guiyang, China
- Key Laboratory of Diagnosis and Treatment of Pulmonary Immuned-related Diseases, NHC, Guiyang, China
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Ishigami J, Kansal M, Mehta R, Srivastava A, Rahman M, Dobre M, Al-Kindi SG, Go AS, Navaneethan SD, Chen J, He J, Bhat ZY, Jaar BG, Appel LJ, Matsushita K. Cardiac Structure and Function and Subsequent Kidney Disease Progression in Adults With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2023; 82:225-236. [PMID: 36935072 PMCID: PMC10440229 DOI: 10.1053/j.ajkd.2023.01.442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/05/2023] [Indexed: 03/19/2023]
Abstract
RATIONALE & OBJECTIVE Heart-kidney crosstalk is recognized as the cardiorenal syndrome. We examined the association of cardiac function and structure with the risk of kidney failure with replacement therapy (KFRT) in a chronic kidney disease (CKD) population. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 3,027 participants from the Chronic Renal Insufficiency Cohort Study. EXPOSURE Five preselected variables that assess different aspects of cardiac structure and function: left ventricular mass index (LVMI), LV volume, left atrial (LA) area, peak tricuspid regurgitation (TR) velocity, and left ventricular ejection fraction (EF) as assessed by echocardiography. OUTCOME Incident KFRT (primary outcome), and annual estimated glomerular filtration rate (eGFR) slope (secondary outcome). ANALYTICAL APPROACH Multivariable Cox models and mixed-effects models. RESULTS The mean age of the participants was 59±11 SD years, 54% were men, and mean eGFR was 43±17mL/min/1.73m2. Between 2003 and 2018 (median follow-up, 9.9 years), 883 participants developed KFRT. Higher LVMI, LV volume, LA area, peak TR velocity, and lower EF were each statistically significantly associated with an increased risk of KFRT, with corresponding HRs for the highest versus lowest quartiles (lowest vs highest for EF) of 1.70 (95% CI, 1.27-2.26), 1.50 (95% CI, 1.19-1.90), 1.43 (95% CI, 1.11-1.84), 1.45 (95% CI, 1.06-1.96), and 1.26 (95% CI, 1.03-1.56), respectively. For the secondary outcome, participants in the highest versus lowest quartiles (lowest vs highest for EF) had a statistically significantly faster eGFR decline, except for LA area (ΔeGFR slope per year, -0.57 [95% CI, -0.68 to-0.46] mL/min/1.73m2 for LVMI, -0.25 [95% CI, -0.35 to-0.15] mL/min/1.73m2 for LV volume, -0.01 [95% CI, -0.12 to-0.01] mL/min/1.73m2 for LA area, -0.42 [95% CI, -0.56 to-0.28] mL/min/1.73m2 for peak TR velocity, and -0.11 [95% CI, -0.20 to-0.01] mL/min/1.73m2 for EF, respectively). LIMITATIONS The possibility of residual confounding. CONCLUSIONS Multiple aspects of cardiac structure and function were statistically significantly associated with the risk of KFRT. These findings suggest that cardiac abnormalities and incidence of KFRT are potentially on the same causal pathway related to the interaction between hypertension, heart failure, and coronary artery diseases. PLAIN-LANGUAGE SUMMARY Heart disease and kidney disease are known to interact with each other. In this study, we examined whether cardiac abnormalities, as assessed by echocardiography, were linked to the subsequent progression of kidney disease among people living with chronic kidney disease (CKD). We found that people with abnormalities in heart structure and function had a greater risk of progression to advanced CKD that required kidney replacement therapy and had a faster rate of decline in kidney function. Our study indicates the potential role of abnormal heart structure and function in the progression of kidney disease among people living with CKD.
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Affiliation(s)
- Junichi Ishigami
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland.
| | - Mayank Kansal
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Rupal Mehta
- Division of Nephrology, Northwestern University, Chicago, Illinois
| | - Anand Srivastava
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Mahboob Rahman
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio; Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Mirela Dobre
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Departments of Epidemiology, Biostatistics and Medicine, University of California-San Francisco, San Francisco, California; Department of Medicine (Nephrology), Stanford University, Palo Alto, California
| | | | - Jing Chen
- Division of Nephrology, Tulane University, New Orleans, Louisiana
| | - Jiang He
- Division of Nephrology, Tulane University, New Orleans, Louisiana
| | | | - Bernard G Jaar
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence J Appel
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
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Zhang L, Zhang X, Xue S. Left Heart Failure Caused by Capacity Overload in Peritoneal Dialysis Patients. Biomed Res Int 2022; 2022:5422333. [PMID: 35607309 PMCID: PMC9124112 DOI: 10.1155/2022/5422333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022]
Abstract
Background This study sets out to investigate the incidence of acute left ventricular failure in peritoneal dialysis patients with different volume loads and to analyze the related risk factors for LVF in these patients. Methods This study involved patients who received peritoneal dialysis in our hospital between September 2018 and January 2021. The demographic data and biochemical indicators of the patients were collected. The bioimpedance analysis method was used to determine the volume overload [overhydration (OH)] level of patients, and cardiac color Doppler ultrasound was used to detect changes in their cardiac structure. According to the LVF diagnostic criteria of symptoms and laboratory tests, the patients were divided into the LVF and non-LVF groups and then divided according to their OH level into the normal volume (OH ≤1.1 L) and volume overload (OH >1.1 L) groups. The incidence of LVF in was analyzed in patients with different volume loads, and logistic regression was used to identify the risk factors for LVF. Results Among the 226 peritoneal dialysis patients enrolled in this study, 125 patients (55.3%) had LVF. The normal volume group (n = 68, 30.1%) included 22 patients (32.4%) with LVF, and the volume overload group (n = 158, 69.9%) included 84 patients (53.2%) with LVF. In the volume overload group, 74 patients (46.8%) had subclinical volume overload, including 35 patients (47.3%) with LVF, and 84 patients (53.2%) had clinical volume overload, including 65 patients (77.4%) LVF. Multivariate logistic regression analysis revealed a high OH level (OR = 1.862, 95% CI: 1.353-2.668, P < 0.001) and low hemoglobin level (OR = 0.845, 95% CI: 0.721-0.980, P = 0.008) to be independent risk factors for LVF. Conclusions LVF has a high incidence in peritoneal dialysis patients, especially those with volume overload. A high OH level and low hemoglobin level are independent risk factors for LVF.
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Affiliation(s)
- Lin Zhang
- Department of Nephrology, Municipal Hospital Affiliated to Xuzhou Medical University, Xuzhou First People's Hospital, Xuzhou, China
| | - Xiaocui Zhang
- Department of Pediatrics, East Hospital of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Song Xue
- Department of Cardiology, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, China
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Tanasa A, Tapoi L, Ureche C, Sascau R, Statescu C, Covic A. Left atrial strain: A novel "biomarker" for chronic kidney disease patients? Echocardiography 2021; 38:2077-2082. [PMID: 34820890 DOI: 10.1111/echo.15259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/04/2021] [Accepted: 11/06/2021] [Indexed: 11/30/2022] Open
Abstract
Cardiovascular disease and chronic kidney disease are frequently inter-connected and this association leads to an exponential growth of cardiovascular risk. This risk is currently underestimated by the existing algorithms and there is a constant need for new markers to predict adverse outcomes in this special population. In general population left atrial strain has emerged as an important tool for both the diagnosis and prognostic stratification, but data regarding its role in chronic kidney disease patients is scarce. The purpose of this review is to summarize the current evidence regarding this matter. Left atrial size and function mirror the duration and severity of increased left ventricular filling pressures. Increased left atrial volume index and impaired left atrial strain parameters are independent predictors for adverse cardiovascular events. Left atrial strain is impaired before changes in volume appear, thus being able to predict both diastolic and systolic function in chronic kidney disease patients. Finally, left atrial strain can identify renal patients with impaired exercise capacity and this could have clinical applications in the rehabilitation of this patients.
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Affiliation(s)
- Ana Tanasa
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Laura Tapoi
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Carina Ureche
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Radu Sascau
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Cristian Statescu
- Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu", Iasi, Romania.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.,Nephrology Department, Dialysis and Renal Transplant Center, "Dr. C.I. Parhon" University Hospital, Iasi, Romania
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Wu PY, Huang JC, Liu YH, Su HM, Chen SC, Chiu YW, Chang JM. Aortic Root Dilatation Is Attenuated with Diabetes but Is Not Associated with Renal Progression in Chronic Kidney Disease. J Pers Med 2021; 11:972. [PMID: 34683112 DOI: 10.3390/jpm11100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
Patients with chronic kidney disease (CKD) often have cardiac functional and structural abnormalities which can lead to adverse cardiovascular outcomes. In this study, we investigated associations between diabetes mellitus (DM) and cardiac functional and structural parameters in patients with CKD focusing on aortic root diameter (ARD). We also investigated associations of renal outcomes with DM and cardiac functional and structural characteristics. We enrolled 419 patients with CKD stage 3–5 were enrolled. ARD was normalized to body surface area (BSA) (ARD/BSA), and the rate of decline in renal function was assessed by the estimated glomerular filtration rate (eGFR) slope (mL/min/1.73 m2/year). ARD/BSA ≥2.1 cm/m2 in men or ≥2.2 cm/m2 in women was defined as indicating aortic root dilatation. The patients with DM had lower ARD/BSA, higher left atrial dimension (LAD), lower left ventricular ejection fraction, lower ratio of peak early transmitral filling wave velocity to peak late transmitral filling wave velocity, and higher left ventricular relative wall thickness, than those without DM. After multivariable analysis, DM (vs. non-DM; coefficient β, −0.060; p = 0.018) was significantly associated with low ARD/BSA. Significantly fewer patients with DM had aortic root dilatation compared to those without DM (14.3% vs. 23.1%, p = 0.022). In the patients with DM, there were significant associations between a high left ventricular mass index (LVMI) (per 1 g/m2, β, −0.016; p = 0.040) and high LAD (per 1 cm; β, −1.965; p < 0.001) with a low eGFR slope. However, other parameters, including ARD/BSA, were not associated with eGFR slope. Furthermore, there were no associations between eGFR slope and any of the echocardiographic parameters in the patients without DM. Aortic root dilatation was attenuated in the patients with DM, but it was not associated with a decline in renal function. However, high LAD and LVMI were associated with rapid renal function decline in the CKD patients with DM.
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