title: Estimated GFR and Subsequent Higher Left Ventricular Mass in Young and Middle-Aged Adults With Normal Kidney Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study.
abstract: BACKGROUND
  Left ventricular hypertrophy is common and is associated with cardiovascular events and death among patients with known chronic kidney disease. However, the link between reduced glomerular filtration rate (GFR) and left ventricular mass index (LVMI) remains poorly explored among young and middle-aged adults with preserved kidney function. In this study, we examined the association of cystatin C-based estimated GFR (eGFRcys) and rapid decline in eGFR with subsequent LVMI.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  We included 2,410 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort with eGFRcys > 60mL/min/1.73m(2) at year 15 and who had an echocardiogram obtained at year 25.
  
  
  METHODS
  eGFRcys at year 15 and rapid decline in eGFRcys (defined as >3% per year over 5 years from years 15 to 20).
  
  
  RESULTS
  LVMI measured at year 25.
  
  
  METHODS
  We adjusted for age, sex, race, diabetes, body mass index, low- and high-density lipoprotein cholesterol levels, cumulative systolic blood pressure, and albuminuria.
  
  
  RESULTS
  Mean age was 40±4 (SD) years, 58% were women, and 43% were black. After 10 years of follow-up, mean LVMI was 39.6±13.4g/m(2.7). Compared with eGFRcys > 90mL/min/1.73m(2) (n = 2,228), eGFRcys of 60 to 75mL/min/1.73m(2) (n = 29) was associated with 5.63 (95% CI, 0.90-10.36) g/m(2.7) greater LVMI (P = 0.02), but there was no association of eGFRcys of 76 to 90mL/min/1.73m(2) (n = 153) with LVMI after adjustment for confounders. Rapid decline in eGFRcys was associated with higher LVMI compared with participants without a rapid eGFRcys decline (β coefficient, 1.48; 95% CI, 0.11-2.83; P = 0.03) after adjustment for confounders.
  
  
  CONCLUSIONS
  There were a limited number of participants with eGFRcys of 60 to 90mL/min/1.73m(2).
  
  
  CONCLUSIONS
  Among young and middle-aged adults with preserved kidney function, eGFRcys of 60 to 75mL/min/1.73m(2) and rapid decline in eGFRcys were significantly associated with subsequently higher LVMI. Further studies are needed to understand the mechanisms that contribute to elevated LVMI in this range of eGFRcys.
authors.affiliation: University of Washington, Kidney Research Institute, Seattle, WA. Electronic address: nbansal@nephrology.washington.edu.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Feng
authors.initials: F
authors.lastname: Lin
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Peralta
authors.affiliation: Johns Hopkins University, Baltimore, MD.
authors.forename: Joao
authors.initials: J
authors.lastname: Lima
authors.affiliation: Loyola University, Chicago, IL.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Shlipak
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000652:urine; D055316:Cystatin C / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000652:urine; D007677:Kidney Function Tests / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
chemical_list: D055316:Cystatin C
keywords: Kidney function; cystatin C; echocardiogram; estimated glomerular filtration rate (eGFR); left ventricular hypertrophy (LVH); left ventricular mass index (LVMI); renal function decline; subclinical cardiovascular disease risk factor