Mild-to-Moderate Kidney Dysfunction and Cardiovascular Disease: Observational and Mendelian Randomization Analyses

BACKGROUND

End-stage renal disease is associated with a high risk of cardiovascular events. It is unknown, however, whether mild-to-moderate kidney dysfunction is causally related to coronary heart disease (CHD) and stroke.

METHODS

Observational analyses were conducted using individual-level data from 4 population data sources (Emerging Risk Factors Collaboration, EPIC-CVD [European Prospective Investigation into Cancer and Nutrition-Cardiovascular Disease Study], Million Veteran Program, and UK Biobank), comprising 648 135 participants with no history of cardiovascular disease or diabetes at baseline, yielding 42 858 and 15 693 incident CHD and stroke events, respectively, during 6.8 million person-years of follow-up. Using a genetic risk score of 218 variants for estimated glomerular filtration rate (eGFR), we conducted Mendelian randomization analyses involving 413 718 participants (25 917 CHD and 8622 strokes) in EPIC-CVD, Million Veteran Program, and UK Biobank.

RESULTS

There were U-shaped observational associations of creatinine-based eGFR with CHD and stroke, with higher risk in participants with eGFR values <60 or >105 mL·min-1·1.73 m-2, compared with those with eGFR between 60 and 105 mL·min-1·1.73 m-2. Mendelian randomization analyses for CHD showed an association among participants with eGFR <60 mL·min-1·1.73 m-2, with a 14% (95% CI, 3%-27%) higher CHD risk per 5 mL·min-1·1.73 m-2 lower genetically predicted eGFR, but not for those with eGFR >105 mL·min-1·1.73 m-2. Results were not materially different after adjustment for factors associated with the eGFR genetic risk score, such as lipoprotein(a), triglycerides, hemoglobin A1c, and blood pressure. Mendelian randomization results for stroke were nonsignificant but broadly similar to those for CHD.

CONCLUSIONS

In people without manifest cardiovascular disease or diabetes, mild-to-moderate kidney dysfunction is causally related to risk of CHD, highlighting the potential value of preventive approaches that preserve and modulate kidney function.

Broad-scale geographic and temporal assessment of northern long-eared bat (Myotis septentrionalis) maternity colony-landscape association

As the federally threatened northern long-eared bat Myotis septentrionalis continues to decline due to white-nose syndrome (WNS) impacts, the application of effective conservation measures is needed but often hindered by the lack of ecological data. To date, recommended management practices have been adopted in part from other federally listed sympatric species such as the endangered Indiana bat M. sodalis. During the maternity season, these measures have largely focused on conservation of known day-roost habitat, often with little consideration for foraging habitat, particularly riparian areas. We examined acoustic activity of northern long-eared bats relative to day-roost and capture data at coastal and interior sites in the District of Columbia, New York, Pennsylvania, Virginia, and West Virginia, USA, over the course of 6 summers (2015-�2020), where maternity activity was still documented after the initial arrival and spread of WNS. Acoustic activity of northern long-eared bats relative to forest cover decreased at the acoustic site level (fine scale) but increased at the sampling region level (coarse scale). We observed a positive association of northern long-eared bat acoustic activity with riparian areas. Additionally, we observed higher levels of activity during pregnancy through early lactation period of the reproductive cycle prior to juvenile volancy. Our findings suggest the need for more explicit inclusion of forested riparian habitats in northern long-eared bat conservation planning. Acoustic sampling in spring and early summer rather than mid- to late summer and in forested riparian areas is the most effective strategy for identifying potential active northern long-eared bat maternity colonies on the local landscape.