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Clinical ResearchChronic Kidney Disease, Heart Failure, and Adverse Cardiac Remodeling in Older Adults: The ARIC Study
Central Illustration
Section snippets
Methods
The prospective ARIC (Atherosclerosis Risk In Communities) cohort study enrolled 15,792 community-dwelling adults between the ages of 45 and 64 years in 1987-1989 (visit 1) from 4 communities in the United States: Forsyth County, North Carolina; Washington County, Maryland; suburban Minneapolis, Minnesota; and Jackson, Mississippi. In 2011-2013, 6,538 participants returned for a fifth study visit (visit 5), at which time they provided blood and urine samples and underwent transthoracic
Associations of kidney dysfunction and damage with risk of incident HF
Among the 5,170 participants initially free of HF included in the analyses of HF outcomes, the mean age was 76 ± 5 years, 2,225 (43%) were men, and 1,217 (24%) were Black (Table 1). The mean eGFR was 66 ± 18 mL/min per 1.73 m2 and the median UACR was 11 (25th, 75th percentiles: 6, 22) mg/g (131 with UACR ≥300 mg/g and 864 with UACR 30 to <300 mg/g). There was a modest inverse correlation between eGFR and UACR at visit 5 (Spearman’s rho = −0.14; P < 0.001) and mildly moderately elevated
Discussion
This study of kidney function and damage, HF, and adverse cardiac remodeling in a biracial, community-dwelling cohort of older adults includes the following principal findings. First, both lower eGFR and higher UACR were independently associated with a heightened risk of incident HF, HFrEF, and HFpEF in late-life. Second, lower eGFR, but not higher UACR, predicted subsequent adverse LV remodeling and worsening diastolic function. Notably, these associations between CKD measures and HF were
Conclusions
In late-life, measures of kidney dysfunction and damage each associate independently with both HFrEF and HFpEF. Lower eGFR associates with LV enlargement and increases in LV filling pressure over 6 years, whereas UACR did not associate with longitudinal changes in cardiac structure or function. This study demonstrates the impact of kidney dysfunction and damage on cardiac structure and function and HF in older adults with mild to moderate kidney disease (Central Illustration).
Funding Support and Author Disclosures
The ARIC study was funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Department of Health and Human Services, under contract nos. HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I. Dr Buckley was supported by NIH/NHLBI grant K23HL150311. Dr Shah was supported by NIH/NHLBI grants R01HL135008, R01HL143224, R01HL150342, R01HL148218, and K24HL152008. Dr Shah
Acknowledgments
The authors thank the staff and participants of the ARIC study for their important contributions.
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