title: Echocardiographic Measures and Estimated GFR Decline Among African Americans: The Jackson Heart Study.
abstract: BACKGROUND
  Cardiac structural abnormalities, common in African Americans, are associated with adverse clinical outcomes. Associations between echocardiography-measured subclinical heart failure and kidney function decline are unknown and may identify novel risk factors for kidney disease in this population.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  2,418 Jackson Heart Study participants with baseline echocardiograms and longitudinal measures of estimated glomerular filtration rate (eGFR) calculated from the CKD-EPI creatinine equation. 2,219 participants had baseline eGFRs≥60mL/min/1.73m2.
  
  
  METHODS
  Left ventricular mass (LVM) and ejection fraction (LVEF) and pulmonary artery systolic pressure (PASP) quantified from baseline echocardiograms.
  
  
  RESULTS
  Primary outcome was >30% eGFR decline or progression to end-stage renal disease (ESRD; need for dialysis therapy) over a mean of 8 years. Secondary outcome, eGFR<60mL/min/1.73m2or progression to ESRD and eGFR decline >1mL/min/1.73m2per year among those with baseline eGFRs≥60mL/min/1.73m2.
  
  
  METHODS
  Logistic regression models, adjusted for demographics, physical characteristics, comorbid conditions, and medication use.
  
  
  RESULTS
  Mean age was 52.2±11.9 (SD) years, 37% of participants were men; mean baseline eGFR was 87.3±17.3mL/min/1.73m2. The primary and secondary outcomes occurred in 148 (6.1%) and 162 (7.1%) participants, respectively. In unadjusted models, every 25-g greater LVM was significantly associated with greater odds of eGFR decline > 30% or ESRD (OR, 1.38; 95% CI, 1.26-1.51) and incident eGFR<60mL/min/1.73m2or ESRD (OR, 1.30; 95% CI, 1.20-1.42); only the former remained statistically significant after adjustment. There was no association of LVEF or PASP with either eGFR decline > 30% or ESRD (LVEF: adjusted OR, 0.95 [95% CI, 0.84-1.07]; PASP: adjusted OR, 0.98 [95% CI, 0.87-1.11]) or incident eGFR<60mL/min/1.73m2or ESRD (LVEF: adjusted OR, 0.98 [95% CI, 0.86-1.11]; PASP: adjusted OR, 1.05 [95% CI, 0.94-1.18]) in multivariable models.
  
  
  CONCLUSIONS
  No midstudy creatinine measurement at examination 2.
  
  
  CONCLUSIONS
  Greater LVM was significantly associated with eGFR decline > 30% or ESRD among African Americans in a community-based cohort. Treating and reversing elevated LVM may reduce the burden and progression of kidney disease in this high-risk population.
authors.affiliation: Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA. Electronic address: lzelnick@uw.edu.
authors.forename: Leila R
authors.initials: LR
authors.lastname: Zelnick
authors.affiliation: Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA; Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, WA; Hospital and Specialty Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA.
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
authors.affiliation: Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Kestenbaum
authors.affiliation: Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.affiliation: Kidney Research Institute, University of Washington, Seattle, WA; Division of Nephrology, University of Washington, Seattle, WA.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
mesh_terms: D001741:Black or African American; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: African Americans; Subclinical heart failure; eGFR decline; echocardiogram; ejection fraction (LVEF); end-stage renal disease (ESRD); estimated glomerular filtration rate (eGFR); incident ESRD; kidney disease progression; kidney function decline; left ventricular mass (LVM); pulmonary artery systolic pressure (PASP)