title: The association between glomerular filtration rate and left ventricular function in two independent community-based cohorts of elderly.
abstract: BACKGROUND
  The cardiorenal syndrome, the detrimental bi-directional interplay between symptomatic heart failure and chronic kidney disease, is a major clinical challenge. Nonetheless, it is unknown if this interplay begins already at an asymptomatic stage. Therefore we investigated whether the glomerular filtration rate (GFR) is associated with left ventricular function in participants free from clinical heart failure and with a left ventricular ejection fraction (LVEF) >40% and with pre-specified sub-group analyses in individuals with a GFR >60 mL/min/m(2).
  
  
  METHODS
  Two independent community-based cohorts were used; the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; n = 911; 50% women; mean age: 70 years) and the Uppsala Longitudinal Study of Adult Men (ULSAM; n = 538; mean age: 71 years). We investigated cross-sectional association between cystatin C-based GFR (estimated glomerular function [eGFR]) and systolic (LVEF), diastolic- (isovolumic relaxation time [IVRT]) and global left ventricular function (myocardial performance index [MPI]) determined by echocardiography.
  
  
  RESULTS
  In both PIVUS and ULSAM, higher eGFR was significantly associated with higher LVEF (P = 0.004 [PIVUS] and P = 0.005 [ULSAM]). In PIVUS, higher eGFR was significantly associated with lower IVRT (P = 0.001) and MPI (P = 0.006), in age- and sex-adjusted models. After further adjustment for cardiovascular risk factors, the association between higher eGFR and higher LVEF was still statistically significant (P = 0.008 [PIVUS] and P = 0.02 [ULSAM]). In PIVUS, the age- and sex-adjusted association between eGFR and left ventricular function was similar in participants with eGFR >60 mL/min/m(2).
  
  
  CONCLUSIONS
  Our data suggest that the interplay between kidney and heart function begins prior to the development of symptomatic heart failure and kidney disease.
authors.affiliation: Department of Public Health and Caring Sciences/Geriatrics, Uppsala Science Park, Uppsala, Sweden Department of Health and Social Sciences, Högskolan Dalarna, Falun, Sweden.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Nerpin
authors.affiliation: Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Ingelsson
authors.affiliation: Department of Public Health and Caring Sciences/Section of Clinical Nutrition and Metabolism, Uppsala Science Park, Uppsala, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Risérus
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Andren
authors.affiliation: Department of Public Health and Caring Sciences/Geriatrics, Uppsala Science Park, Uppsala, Sweden Department of Health and Social Sciences, Högskolan Dalarna, Falun, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Jobs
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Larsson
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Lind
authors.initials: L
authors.lastname: Lars
authors.affiliation: Department of Public Health and Caring Sciences/Geriatrics, Uppsala Science Park, Uppsala, Sweden Department of Health and Social Sciences, Högskolan Dalarna, Falun, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Ärnlöv
mesh_terms: D000368:Aged; D059347:Cardio-Renal Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013548:Sweden / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: chronic kidney disease; cystatin C; glomerular filtration rate; heart failure; left ventricular dysfunction