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Association of Left Atrial Function With Incident Chronic Kidney Disease in Older Adults.
- Source :
-
Mayo Clinic proceedings. Innovations, quality & outcomes [Mayo Clin Proc Innov Qual Outcomes] 2024 Jun 12; Vol. 8 (4), pp. 343-355. Date of Electronic Publication: 2024 Jun 12 (Print Publication: 2024). - Publication Year :
- 2024
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Abstract
- Objective: To examine the association of left atrial (LA) function with incident chronic kidney disease (CKD) and assess the clinical utility of adding LA function to a CKD risk prediction equation.<br />Patients and Methods: We included 4002 Atherosclerosis Risk in Communities study participants without prevalent CKD (mean ± SD age, 75±5 years; 58% female, 18% Black). Left atrial function (reservoir, conduit, and contractile strain) was evaluated by 2D-echocardiograms on 2011 to 2013. Chronic kidney disease was defined as greater than 25% decline in estimated glomerular filtration rate of less than 60 mL/min/1.73 m <superscript>2</superscript> , end-stage kidney disease, or hospital records. Cox proportional hazards models were used. Risk prediction and decision curve analyses evaluated 5-year CKD risk by diabetes status.<br />Results: Median follow-up was 7.2 years, and 598 participants developed incident CKD. Incidence rate for CKD was 2.29 per 100 person-years. After multivariable adjustments, the lowest quintile of LA reservoir, conduit, and contractile strain (vs highest quintile) had a higher risk of CKD (hazard ratios [95% CIs]: 1.94 [1.42-2.64], 1.62 [1.19-2.20], and 1.49 [1.12-1.99]). Adding LA reservoir strain to the CKD risk prediction equation variables increased the C-index by 0.026 (95% CI: 0.005-0.051) and 0.031 (95% CI: 0.006-0.058) in participants without and with diabetes, respectively. Decision curve analysis found the model with LA reservoir strain had a higher net benefit than the model with CKD risk prediction equation variables alone.<br />Conclusion: Lower LA function is independently associated with incident CKD. Adding LA function to the CKD risk prediction enhances prediction and yields a higher clinical net benefit. These findings suggest that impaired LA function may be a novel risk factor for CKD.<br />Competing Interests: Dr Eaton reported grant support from the National Institutes of Health to the institution. Dr Herzog reported grant support from the National Heart, Lung, and Blood Institute, National Institutes of Health to the institution, consulting fees from Astra-Zeneca, personal fees from Merck (DSMB) for participation on a Data Safety Monitoring, and stock ownership in Merck, Pfizer and Boston Scientific. Dr Matsushita reported grant supports from the National Institutes of Health and Resolve to Save Lives, consulting fees from Fukuda Denshi and RhythmX AI. Dr Coresh reported grant supports from the National Institutes of Health and National Kidney Foundation, consulting fees from Healthy.IO, and stock ownership in Healthy.IO. Dr Shah reported funding from Novartis and Philips Ultrasound, and consulting fees from Philips Ultrasound and Janssen outside the submitted work. Dr Solomon reported funding from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, BMS, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lilly, Mesoblast, MyoKardia, NIH/NHLBI, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, Theracos, US2.AI grant to institution, outside the submitted work and personal fees from Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boeringer-Ingelheim, BMS, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi- Sankyo, GSK, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, SanofiPasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, Sarepta, Lexicon, Anacardio, Akros, PureHealth consulting outside the submitted work. The other authors declare no competing interests.<br /> (© 2024 The Authors.)
Details
- Language :
- English
- ISSN :
- 2542-4548
- Volume :
- 8
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Mayo Clinic proceedings. Innovations, quality & outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 38974529
- Full Text :
- https://doi.org/10.1016/j.mayocpiqo.2024.05.001