title: Left atrial diameter and albumin with renal outcomes in chronic kidney disease.
abstract: OBJECTIVE
  Echocardiographic left atrial diameter (LAD) has been documented to be an independent predictor of adverse cardiovascular outcomes in various populations. An enlarged left atrium is frequently noted in chronic kidney disease (CKD). We examined the association between albumin and indexed LAD (indexed to height) and assessed whether the combination of indexed LAD and albumin was independently associated with renal outcomes in patients with CKD stages 3-5.
  
  
  METHODS
  This longitudinal study enrolled 395 patients, who were classified into four groups according to median values of indexed LAD (LAD/height) and albumin. The change in renal function was measured by estimated glomerular filtration rate (eGFR) slope. Rapid renal progression was defined as eGFR slope less than -3 ml/min/1.73 m(2)/year. The renal end point was defined as commencement of dialysis.
  
  
  RESULTS
  Albumin was significantly associated with indexed LAD (β = -0.108, P = 0.024). During follow-up period, seventy-four patients started dialysis. After the multivariate analysis, the group with higher indexed LAD and lower albumin was independently associated with rapid renal progression (odds ratio, 7.979; 95% confidence interval [CI], 3.028 to 21.025) and progression to dialysis (hazard ratio, 2.352; 95% CI, 1.078 to 5.131).
  
  
  CONCLUSIONS
  Our findings show that albumin is independently associated with indexed LAD and suggest that the combination of increased indexed LAD and hypoalbuminemia is independently associated with rapid renal progression and progression to dialysis in patients with CKD. Assessments of serum albumin and indexed LAD by echocardiography are useful for predicting the risk for adverse renal outcomes.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 812 Kaohsiung, Taiwan.
authors.forename: Szu-Chia
authors.initials: SC
authors.lastname: Chen
authors.forename: Jer-Ming
authors.initials: JM
authors.lastname: Chang
authors.forename: Yi-Chun
authors.initials: YC
authors.lastname: Tsai
authors.forename: Jiun-Chi
authors.initials: JC
authors.lastname: Huang
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Hung-Chun
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000368:Aged; D000418:Albumins / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000473:pathology*; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006325:Heart Atria / Q000033:anatomy & histology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000473:pathology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*
chemical_list: D000418:Albumins
keywords: albumin; chronic kidney disease; indexed left atrial diameter; renal function progression.