Echocardiographic Measures and Estimated GFR Decline Among African Americans: The Jackson Heart Study.
Echocardiographic Measures and Estimated GFR Decline Among African Americans: The Jackson Heart Study.
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非裔美国人的超声心动图测量和估计 GFR 下降：杰克逊心脏研究。
DOI：
10.1053/j.ajkd.2016.11.022
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Bansal,Nisha
中科院分区：
文献类型：
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作者：
Zelnick,LeilaR;Katz,Ronit;Young,BessieA;Correa,Adolfo;Kestenbaum,BryanR;deBoer,IanH;Bansal,Nisha
背景心脏结构异常，常见于非洲裔美国人，与不良的临床结果。超声心动图测量的亚临床心力衰竭和肾功能下降之间的关系尚不清楚，可能会发现新的危险因素，肾脏疾病在这一population.Study设计前瞻性队列研究设置和研究人员2,418杰克逊心脏研究参与者与基线超声心动图和纵向措施估计肾小球滤过率（eGFR）计算CKD-EPI肌酐方程。2，219名参与者基线eGFR ≥ 60 mL/min/1.73 m2。预测指标从基线超声心动图定量左心室质量（LVM）、射血分数（LVEF）和肺动脉收缩压（PASP）。结果主要结果是平均8年eGFR下降>30%或进展为终末期肾病（ESRD;需要透析治疗）。次要结局，基线eGFR ≥ 60 mL/min/1.73 m2的患者中，eGFR <60 mL/min/1.73 m2或进展为ESRD且eGFR每年下降>1 mL/min/1.73 m2。测量Logistic回归模型，校正人口统计学、身体特征、共病状况和药物使用。37%的参与者为男性;平均基线eGFR为87.3 ± 17.3 mL/min/1.73 m2。主要和次要结局分别发生在148例（6.1%）和162例（7.1%）受试者中。在未校正的模型中，左心室质量每增加25 g，eGFR下降> 30%或ESRD（OR，1.38; 95% CI，1.26-1.51）和事件eGFR < 60 mL/min/1.73 m2或ESRD（OR，1.30; 95% CI，1.20-1.42）的几率就更大;只有前者在校正后仍具有统计学意义。LVEF或PASP与eGFR下降> 30%或ESRD无关（LVEF：校正OR，0.95 [95% CI，0.84-1.07]; PASP：校正OR，0.98 [95% CI，0.87-1.11]）或事件eGFR < 60 mL/min/1.73 m2或ESRD（LVEF：调整后OR，0.98 [95%CI，0.86-1.11]; PASP：调整后OR，1.05 [95%CI，0.94-1.18]）。局限性研究中期检查时无肌酐测量2.结论在社区队列中，在非裔美国人中，较大的左心室质量与eGFR下降> 30%或终末期肾病显著相关。治疗和逆转左心室质量升高可能会减少这一高危人群的肾脏疾病负担和进展。
BackgroundCardiac structural abnormalities, common in African Americans, are associated with adverse clinical outcomes. Associations between echocardiography-measured subclinical heart failure and kidney function decline are unknown and may identify novel risk factors for kidney disease in this population.Study DesignProspective cohort study.Setting & Participants2,418 Jackson Heart Study participants with baseline echocardiograms and longitudinal measures of estimated glomerular filtration rate (eGFR) calculated from the CKD-EPI creatinine equation. 2,219 participants had baseline eGFRs ≥ 60 mL/min/1.73 m2.PredictorsLeft ventricular mass (LVM) and ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) quantified from baseline echocardiograms.OutcomesPrimary outcome was >30% eGFR decline or progression to end-stage renal disease (ESRD; need for dialysis therapy) over a mean of 8 years. Secondary outcome, eGFR < 60 mL/min/1.73 m2or progression to ESRD and eGFR decline >1 mL/min/1.73 m2per year among those with baseline eGFRs ≥ 60 mL/min/1.73 m2.MeasurementsLogistic regression models, adjusted for demographics, physical characteristics, comorbid conditions, and medication use.ResultsMean age was 52.2 ± 11.9 (SD) years, 37% of participants were men; mean baseline eGFR was 87.3 ± 17.3 mL/min/1.73 m2. The primary and secondary outcomes occurred in 148 (6.1%) and 162 (7.1%) participants, respectively. In unadjusted models, every 25-g greater LVM was significantly associated with greater odds of eGFR decline > 30% or ESRD (OR, 1.38; 95% CI, 1.26-1.51) and incident eGFR < 60 mL/min/1.73 m2or ESRD (OR, 1.30; 95% CI, 1.20-1.42); only the former remained statistically significant after adjustment. There was no association of LVEF or PASP with either eGFR decline > 30% or ESRD (LVEF: adjusted OR, 0.95 [95% CI, 0.84-1.07]; PASP: adjusted OR, 0.98 [95% CI, 0.87-1.11]) or incident eGFR < 60 mL/min/1.73 m2or ESRD (LVEF: adjusted OR, 0.98 [95% CI, 0.86-1.11]; PASP: adjusted OR, 1.05 [95% CI, 0.94-1.18]) in multivariable models.LimitationsNo midstudy creatinine measurement at examination 2.ConclusionsGreater LVM was significantly associated with eGFR decline > 30% or ESRD among African Americans in a community-based cohort. Treating and reversing elevated LVM may reduce the burden and progression of kidney disease in this high-risk population.