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Kidney Week

Abstract: PO2125

Left Atrial Reservoir Strain Is an Independent Predictor of End-Stage Renal Impairment in Patients with CKD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Gan, Gary, Blacktown & Mount Druitt Hospital, Blacktown, New South Wales, Australia
  • Kadappu, Krishna K., Campbelltown Hospital, Campbelltown, New South Wales, Australia
  • Bhat, Aditya, Blacktown & Mount Druitt Hospital, Blacktown, New South Wales, Australia
  • Fernandez, Fernando, Blacktown & Mount Druitt Hospital, Blacktown, New South Wales, Australia
  • Gu, Kennith H., Blacktown & Mount Druitt Hospital, Blacktown, New South Wales, Australia
  • Eshoo, Suzanne, Blacktown & Mount Druitt Hospital, Blacktown, New South Wales, Australia
  • Nankivell, Brian John, Westmead Hospital, Westmead, New South Wales, Australia
  • Thomas, Liza, Westmead Hospital, Westmead, New South Wales, Australia
Background

Left atrial (LA) enlargement is common in patients with chronic kidney disease (CKD) and is a predictor of adverse cardiovascular events. Our study sought to evaluate the value of LA reservoir strain (LAs), a novel echocardiographic measure of LA function, as a prognostic marker of adverse renal outcomes.

Methods

Patients with stable Stage 3 and 4 CKD without prior cardiac history were prospectively recruited and underwent transthoracic and stress echocardiography. Patients with normal left ventricular (LV) function, without significant valvular disease and without ischaemia on stress testing were included and followed for up to 5 years for development of end stage renal disease (ESRD) and/or doubling of serum creatinine.

Results

280 patients (65.8±12.2years, 63% male) were recruited and followed for a mean period of 3.9±2.7years. 56 patients developed the composite endpoint. On log rank tests, impaired LAs (Figure 1), older age, lower eGFR, anemia, diabetes mellitus, greater urinary albumin/creatinine, greater number of antihypertensive agents, higher indexed LV mass and larger LA volumes were significant predictors of the composite outcome (p<0.01 for all). On Multi-variable Cox proportional hazards regression analysis, impaired LAs in addition to eGFR, number of antihypertensive agents and urinary albumin/creatinine (p<0.01 for all) were independent predictors of ESRD and/or doubling of serum creatinine. Impaired LAs was associated with a 2.5-fold higher risk of the composite outcome.

Conclusion

LAs is an independent predictor for development of ESRD and/or doubling of serum creatine and thus has the potential to be a ‘biomarker’ for identification of high-risk patients, enabling early initiation of therapy.