title: Subclinical cardiac abnormalities and kidney function decline: the multi-ethnic study of atherosclerosis.
abstract: OBJECTIVE
  Clinical heart failure (HF) is associated with CKD and faster rates of kidney function decline. Whether subclinical abnormalities of cardiac structure are associated with faster kidney function decline is not known. The association between cardiac concentricity and kidney function decline was evaluated.
  
  
  METHODS
  This is a longitudinal study of 3866 individuals from the Multi-Ethnic Study of Atherosclerosis (2000-2007) who were free of clinical cardiovascular disease, with an estimated GFR (eGFR) ≥60 ml/min per 1.73 m(2) at baseline and 5 years of follow-up. Concentricity, a measurement of abnormal cardiac size, was assessed by magnetic resonance imaging and evaluated as a continuous measurement and in quartiles. GFR was estimated by creatinine (eGFRcr) and cystatin C (eGFRcys). The association of concentricity with annual eGFR decline, incident CKD, and rapid kidney function decline (>5% per year) was investigated using linear mixed models as well as Poisson and logistic regression, respectively. Analyses adjusted for demographics, BP, diabetes, and inflammatory markers.
  
  
  RESULTS
  Median decline was -0.8 (interquartile range, -3.1, -0.5) by eGFRcr. Compared with the lowest quartile of concentricity, persons in the highest quartile had an additional 21% (9%-32%) decline in mean eGFRcr in fully adjusted models. Concentricity was also associated with incident CKD and with rapid kidney function decline after adjustment.
  
  
  CONCLUSIONS
  Subclinical abnormalities in cardiac structure are associated with longitudinal kidney function decline independent of diabetes and hypertension. Future studies should examine mechanisms to explain these associations.
authors.affiliation: Division of Nephrology, Department of Medicine, University of California, San Francisco, CA 94121, USA. meyeon.park@ucsf.edu
authors.forename: Meyeon
authors.initials: M
authors.lastname: Park
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Subhashish
authors.initials: S
authors.lastname: Agarwal
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
authors.forename: Chi-Yuan
authors.initials: CY
authors.lastname: Hsu
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
mesh_terms: D001741:Black or African American; D001213:Asian; D050197:Atherosclerosis / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006630:Hispanic or Latino; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009929:Organ Size; D051436:Renal Insufficiency, Chronic / Q000209:etiology; D044465:White People