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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

Category: CKD (Non-Dialysis)

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


  • Wang, Angela Yee Moon, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
  • Wu, Henry Hon Lin, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
  • Cai, Qizhe, Beijing Chao-Yang Hospital, Beijing, China
  • Wong, Hoi Kei Sarah, University of Hong Kong, Hong Kong, China
  • Lu, Xiuzhang, Beijing Chao-Yang Hospital, Beijing, China

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


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.


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.


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.