Kidney Week

Abstract: TH-PO1137

Kidney and Cardiac Parameters – Which Are More Important in Predicting Circulatory Congestion and Mortality Risk in CKD? Insights from a 5-Year Prospective Analysis

Session Information

• CKD: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Wang, Angela Yee Moon, Queen Mary Hospital, University of Hong Kong, Hong Kong, China

Angela Yee Moon Wang,

• Wu, Henry Hon Lin, Queen Mary Hospital, University of Hong Kong, Hong Kong, China

Henry Hon Lin Wu,

• Cai, Qizhe, Beijing Chao-Yang Hospital, Beijing, China

Qizhe Cai,

• Wong, Hoi Kei Sarah, University of Hong Kong, Hong Kong, China

Hoi Kei Sarah Wong,

• Lu, Xiuzhang, Beijing Chao-Yang Hospital, Beijing, China

Xiuzhang Lu,

Background

Chronic kidney disease (CKD) patients are frequently complicated with circulatory congestion (CC). However, factors predicting the risk of CC are poorly understood.

Methods

300 CKD stage 3-5 subjects (Mean age, 60±10yrs, 56.3% men) were randomly recruited from a University Teaching Hospital. All underwent 2D-echocardiography & tissue Doppler imaging (TDI) to assess cardiac structure & function, bloods & first void urine collection for eGFR & urine protein to creatinine ratio (UPCR), & blood pressure measurement.

Results

eGFR (mean±SD): 33 ± 17ml/min per 1.73m². Urine UPCR: 139 ± 202mg/mmol creatinine. All subjects were followed prospectively for a median of 68 (IQR, 30, 70) mths, 25% were complicated with CC or died from other causes. In the multivariable Cox regression analysis considering clinical, hemodynamic, biochemical, echo & TDI parameters, eGFR (P=0.002) & UPCR (P=0.006) exhibited independent significance in predicting the risk of CC & mortality. Additional adjustment for cardiovascular medications including renin-angiotensin system blockers, beta-blockers, & diuretics did not change the significance of eGFR & UPCR in predicting CC & mortality. In a receiver-operator-characteristics curve analysis, UPCR showed the largest area under the curve (AUC) (0.78, 95% confidence intervals [CI], 0.72 - 0.84) in predicting the composite endpoint of CC & mortality, followed by eGFR (0.75, 95% CI, 0.69 - 0.81) & the ratio of early mitral inflow velocity to peak mitral annulus velocity (E/Em ratio, a marker of left ventricular [LV] filling pressure) (0.74, 95% CI, 0.67 – 0.80). The AUC of LV mass index & ejection fraction was 0.72 (95% CI, 0.65 - 0.79) & 0.50 (95% CI, 0.42 – 0.58), respectively.

Conclusion

Both proteinuria & eGFR exhibited independent significance & were more powerful than cardiac structural & functional parameters in predicting CC & mortality risk in CKD. Among the cardiac parameters, diastolic dysfunction outweighed systolic dysfunction in predicting CC & mortality risk. Further intervention study is needed to evaluate whether retarding proteinuria & CKD progression may effectively lower the incidence of CC and improve clinical outcomes of CKD patients.