Abnormalities in heart structure and function may increase risk of advanced CKD requiring kidney replacement therapy

An original investigation has highlighted a significant correlation between Cardiac structure and function and the risk of KFRT (kidney failure with replacement therapy).

This study entitled “Cardiac Structure and Function and Subsequent Kidney Disease Progression in Adults With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study” was published in the American Journal of Kidney Diseases.

Cardiorenal syndrome means “heart-kidney crosstalk”, meaning a spectrum of disorders involving both the heart and kidneys: dysfunction in 1 organ induces acute or chronic dysfunction in the other organ.

Investigating further, researchers examined the association of cardiac function and structure with the risk of KFRT in the chronic kidney disease (CKD) population. They included 3,027 participants with a mean age of 59 years, including 54 % men and a mean eGFR of 43 ml/min/1.73m2 from the Chronic Renal Insufficiency Cohort Study.

To assess cardiac structure and functions by echocardiography, they included the following variables:

• Left ventricular mass index (LVMI)
• LV volume
• Left atrial (LA) area
• Peak tricuspid regurgitation (TR) velocity
• Left ventricular ejection fraction (EF)

The primary and secondary Outcomes were Incident KFRT and annual eGFR slope.

The results of the study could be summarised as:

• The follow-up duration was 9.9 years.
• Eight hundred eighty-three patients developed KFRT.
• Higher LVMI, LV volume, LA area, peak TR velocity, and lower EF were related to an increased KFRT risk.
• The corresponding HRs for the highest vs lowest quartiles of 1.70, 1.50, 1.43, 1.45 and 1.26, respectively.

Considering the secondary outcome, participants in the highest vs lowest quartiles had faster eGFR decline, except for LA area ; ΔeGFR slope per year, -0.57 mL/min/1.73m2 for LVMI, -0.25 mL/min/1.73m2 for LV volume, -0.01 mL/min/1.73m2 for LA area, -0.42 mL/min/1.73m2 for peak TR velocity, and -0.11 mL/min/1.73m2 for EF, respectively.

The possibility of residual confounding was the limitation of the study.

Concluding further, they said there is a significant association between Multiple aspects of cardiac structure and function and KFRT risk.

The causal pathway is the same for cardiac abnormalities and KFRT incidence, related to the interaction between hypertension, heart failure, and coronary artery diseases.

Further reading:

Cardiac Structure and Function and Subsequent Kidney Disease Progression in Adults With CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study Published: March 17, 2023DOI:

https://doi.org/10.1053/j.ajkd.2023.01.442