title: Markers of kidney disease and risk of subclinical and clinical heart failure in African Americans: the Jackson Heart Study.
abstract: African Americans and patients with chronic kidney disease (CKD) are at high risk for clinical heart failure (HF). In this study, we aimed to determine the association of markers of kidney disease with subclinical HF (by echocardiogram) and risk of clinical HF among a large, well-characterized community-based cohort of African American patients. We also examined whether the association of markers of kidney disease with HF was attenuated with adjustment for echocardiographic measures.
  
  
  
  We studied participants in the Jackson Heart Study, a large community-based cohort of African Americans. Estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (ACR) were measured at baseline. We tested the association of eGFR and urine ACR with left ventricular mass (LVM), left ventricular ejection fraction (LVEF) and physician-adjudicated incident HF.
  
  
  
  Among the 3332 participants in the study, 166 (5%) had eGFR <60 mL/min/1.73 m2and 405 (12%) had urine ACR ≥30 mg/g. In models adjusted for demographics, comorbidity and the alternative measure of kidney disease, lower eGFR and higher urine ACR were associated with higher LVM {β-coefficient 1.54 [95% confidence interval (CI) 0.78-2.31] per 10 mL/min/1.73 m2decrease in eGFR and 2.87 (95% CI 1.85-3.88) per doubling of urine ACR}. There was no association of eGFR and urine ACR with LVEF [β-coefficient -0.12 (95% CI -0.28-0.04) and -0.11 (95% CI -0.35-0.12), respectively]. There was no association of eGFR with the risk of incident HF [HR 1.02 (95% CI 0.91-1.14) per 10 mL/min/1.73 m2decrease], while there was a significant association of urine ACR [HR 2.22 (95% CI 1.29-3.84) per doubling of urine ACR]. This association was only modestly attenuated with adjustment for LVM [HR 1.95 (95% CI 1.09-3.49)].
  
  
  
  Among a community-based cohort of African Americans, lower eGFR and higher ACR were associated with higher LVM. Furthermore, higher urine ACR was associated with incident HF, which was not entirely explained by the presence of left ventricular disease.
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, 908 Jefferson Street, 3rd floor, Seattle, WA, USA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, 908 Jefferson Street, 3rd floor, Seattle, WA, USA.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, 908 Jefferson Street, 3rd floor, Seattle, WA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, 908 Jefferson Street, 3rd floor, Seattle, WA, USA.
authors.forename: Maryam
authors.initials: M
authors.lastname: Afkarian
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, 908 Jefferson Street, 3rd floor, Seattle, WA, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, 908 Jefferson Street, 3rd floor, Seattle, WA, USA.|Hospital and Specialty Medicine, Nephrology Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.affiliation: Kidney Research Institute, Division of Nephrology, University of Washington, 908 Jefferson Street, 3rd floor, Seattle, WA, USA.|Hospital and Specialty Medicine, Nephrology Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
mesh_terms: D001741:Black or African American; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology / Q000652:urine; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000652:urine; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000652:urine*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine*; D012306:Risk; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers
keywords: African Americans; chronic kidney disease; echocardiogram; heart failure; left ventricular hypertrophy