Document Detail


Left ventricular hypertrophy in mild and moderate reduction in kidney function determined using cardiac magnetic resonance imaging and cystatin C: the multi-ethnic study of atherosclerosis (MESA).
MedLine Citation:
PMID:  18845370     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Left ventricular (LV) hypertrophy (LVH) is associated with chronic kidney disease, but the association of LVH with a mild decrease in kidney function is not known. We hypothesized that mild and moderate decreases in kidney function, reflected in greater serum cystatin C concentrations, would be linearly associated with a greater prevalence of LVH.
STUDY DESIGN: Cross-sectional observational study.
SETTINGS & PARTICIPANTS: Participants in baseline examinations in the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based study with several sites in the United States.
PREDICTORS: Cystatin C-based estimated glomerular filtration rate (eGFR(cysC)) and creatinine-based eGFR.
OUTCOMES: LVH and LV mass index.
MEASUREMENTS: Serum cystatin C and creatinine, LV mass obtained by using magnetic resonance imaging. LVH cutoff values for men and women were defined by the upper 95th percentile of LV mass index of all MESA participants without hypertension.
RESULTS: Of the 4,971 participants analyzed, mean creatinine-based eGFR was 81 +/- 17 (SD) mL/min/1.73 m(2) and mean eGFR(cysC) was 94 +/- 32 mL/min/1.73 m(2). LVH was distinctly more prevalent (>12%) in only the lowest 2 deciles of eGFR(cysC) (<75 mL/min/1.73 m(2)). When 435 participants (9%) with stage 3 or higher chronic kidney disease (creatinine-based eGFR < 60 mL/min/1.73 m(2)) were excluded, the odds for LVH increased for each lower category of eGFR(cysC) less than 75 mL/min/1.73 m(2): odds ratio 1.6 for LVH with eGFR(cysC) of 60 to 75 mL/min/1.73 m(2) (95% confidence interval, 1.20 to 2.07; P = 0.001), and odds ratio 2.0 for eGFR(cysC) less than 60 mL/min/1.73 m(2) (95% confidence interval, 1.03 to 3.75; P = 0.04) after adjustment for demographic factors, study site, diabetes, and smoking. The association of lower eGFR(cysC) with LVH was attenuated after further adjustment for hypertension.
LIMITATIONS: Cross-sectional rather than longitudinal design, lack of participants with more advanced kidney disease, lack of a direct measurement of glomerular filtration rate.
CONCLUSIONS: In participants without chronic kidney disease, eGFR(cysC) of 75 mL/min/1.73 m(2) or less was associated with a greater odds of LVH.
Authors:
Andrew Moran; Ronit Katz; Nancy Swords Jenny; Brad Astor; David A Bluemke; João A C Lima; David Siscovick; Alain G Bertoni; Michael G Shlipak
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2008-10-08
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  52     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-30     Completed Date:  2008-11-13     Revised Date:  2012-03-07    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  839-48     Citation Subset:  IM    
Affiliation:
Division of General Internal Medicine, Department of Medicine, Columbia University, New York, NY, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00005487
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MeSH Terms
Descriptor/Qualifier:
African Americans
Aged
Aged, 80 and over
Asian Continental Ancestry Group
Cross-Sectional Studies
Cystatin C
Cystatins / blood*
European Continental Ancestry Group
Female
Hispanic Americans
Humans
Hypertrophy, Left Ventricular / blood*,  complications,  diagnosis*
Kidney Diseases / blood*,  complications,  physiopathology
Magnetic Resonance Imaging*
Male
Middle Aged
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
N01 HC095159/HC/NHLBI NIH HHS; N01 HC095160/HC/NHLBI NIH HHS; N01 HC095161/HC/NHLBI NIH HHS; N01 HC095162/HC/NHLBI NIH HHS; N01 HC095163/HC/NHLBI NIH HHS; N01 HC095164/HC/NHLBI NIH HHS; N01 HC095165/HC/NHLBI NIH HHS; N01 HC095166/HC/NHLBI NIH HHS; N01-HC-95159/HC/NHLBI NIH HHS; N01-HC-95165/HC/NHLBI NIH HHS; N01-HC-95166/HC/NHLBI NIH HHS; Z99 CL999999/CL/CLC NIH HHS
Chemical
Reg. No./Substance:
0/CST3 protein, human; 0/Cystatin C; 0/Cystatins
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