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Am J Kidney Dis. 2019 Sep;74(3):373-381. doi: 10.1053/j.ajkd.2019.02.013. Epub 2019 Apr 26.

Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study.

Author information

1
Gotanda Garden Clinic, Tokyo, Japan.
2
Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
3
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
4
Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.
5
Shin-eikai Hospital, Fukuoka, Japan.
6
Division of General Internal Medicine, Kyushu Dental University, Kitakyushu, Japan.
7
Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
8
Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. Electronic address: nino@eph.med.kyushu-u.ac.jp.

Abstract

RATIONALE & OBJECTIVE:

Evidence suggests that cardiac remodeling, including left ventricular hypertrophy and myocardial fibrosis, develops with progression of kidney disease. Few studies have examined cardiac pathology across a range of estimated glomerular filtration rates (eGFRs), which was the objective of this investigation.

STUDY DESIGN:

Population-based cross-sectional study of deceased patients undergoing autopsy.

SETTING & PARTICIPANTS:

334 of 694 consecutive deceased patients undergoing autopsy with available cardiac tissue, with a prior health examination within 6 years and without a prior diagnosis of heart disease.

EXPOSURE:

eGFR.

OUTCOMES:

The thickness of the left ventricular wall, sizes of cardiac cells, and percentages of fibrosis, estimated from pathology examination of autopsy samples.

ANALYTICAL APPROACH:

Generalized estimating equations.

RESULTS:

Lower eGFRs were associated with greater left ventricular wall thickness. Deceased patients with eGFRs≥60, 45 to 59, 30 to 44, and <30mL/min/1.73m2 had left ventricular wall thicknesses of 9.1, 9.5, 9.8, and 10.3mm, respectively (P for trend<0.05). Lower eGFRs were also significantly associated with greater mean values of cardiac cell size in the left ventricular wall after adjusting for confounders: 15.3, 16.1, 16.4, and 17.4μm for eGFRs≥60, 45 to 59, 30 to 44, and <30mL/min/1.73m2 (P for trend<0.01). Patients with lower eGFRs had significantly higher multivariable-adjusted geometric mean values for fibrosis percentage in the left ventricular wall: 3.22%, 4.33%, 3.83%, and 6.14% for eGFRs≥60, 45 to 59, 30 to 44, and <30mL/min/1.73m2 (P for trend<0.001). The negative association of eGFR with multivariable-adjusted mean values of cardiac cell width was stronger among patients with than those without anemia.

LIMITATIONS:

Cross-sectional study with a high proportion of elderly patients, no available information for severity or duration of hypertension and other cardiovascular risk factors, no information for medication use.

CONCLUSIONS:

These findings suggest that reduced eGFR is associated with cardiac hypertrophy and fibrosis of the left ventricle, cardiac cell enlargement, and cardiac fibrosis.

KEYWORDS:

Chronic kidney disease (CKD); autopsy; cardiac fibrosis; cardiac hypertrophy; cardiac remodeling; estimated glomerular filtration rate (eGFR); histology; morphology

PMID:
31036390
DOI:
10.1053/j.ajkd.2019.02.013
[Indexed for MEDLINE]
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