Elsevier

JACC: Heart Failure

Volume 11, Issue 5, May 2023, Pages 523-537
JACC: Heart Failure

Clinical Research
Chronic Kidney Disease, Heart Failure, and Adverse Cardiac Remodeling in Older Adults: The ARIC Study

https://doi.org/10.1016/j.jchf.2023.01.029Get rights and content

Abstract

Background

The associations of kidney dysfunction and damage with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), as well as adverse cardiac remodeling, in late-life remain incompletely understood.

Objectives

The authors sought to define the associations between kidney dysfunction and damage and incident HFrEF and HFpEF and cardiac structure and function in late-life.

Methods

This study included 5,170 adults initially free of a heart failure (HF) diagnosis who had estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) measured at visit 5 (2011-2013) of the ARIC (Atherosclerosis Risk In Communities) study. Multivariable Cox proportional hazards models were used to estimate the associations of eGFR and UACR with incident HF, HFrEF, and HFpEF through 2019. Multivariable linear regression models were used to investigate the associations of eGFR and UACR at visit 5 with changes in cardiac structure and function between visits 5 and 7 in 2,313 participants with available echocardiograms.

Results

The mean age of participants was 76 ± 5 years, and 2,225 (43%) were men. The mean eGFR and median UACR were 66 ± 18 mL/min/1.73 m2 and 11 mg/g (25th, 75th percentile: 6, 22 mg/g), respectively. In fully adjusted models, both lower eGFR and higher UACR were associated with greater risk of any HF, HFrEF, and HFpEF. Lower eGFR was associated with larger increases in left ventricular end-diastolic volume index and worsening of diastolic measures. UACR did not associate with changes in cardiac structure or function.

Conclusions

Mild to moderate kidney dysfunction and damage associate with incident HF and adverse cardiac remodeling in late-life.

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).

COMPETENCY IN

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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