The association between glomerular filtration rate and left ventricular function in two independent community-based cohorts of elderly

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2014-11, Vol.29 (11), p.2069-2074
• Main Authors: Nerpin, Elisabet, Ingelsson, Erik, Risérus, Ulf, Sundström, Johan, Andren, Bertil, Jobs, Elisabeth, Larsson, Anders, Lars, Lind, Ärnlöv, Johan
• Format: Article
• Language: English
• Subjects: Aged; Cardio-Renal Syndrome - diagnosis; Cardio-Renal Syndrome - epidemiology; Cardio-Renal Syndrome - physiopathology; chronic kidney disease; CLINICAL SCIENCE; Cross-Sectional Studies; cystatin C; Disease Progression; Echocardiography; Epidemiologi; Epidemiology; Female; Geriatric Assessment - methods; Geriatrics; Geriatrik; glomerular filtration rate; Glomerular Filtration Rate - physiology; Health and Welfare; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hälsa och välfärd; Incidence; left ventricular dysfunction and heart failure; Male; Prognosis; Prospective Studies; Risk Factors; Stroke Volume - physiology; Sweden - epidemiology; Ventricular Function, Left - physiology
• ISSN: 0931-0509; 1460-2385; 1460-2385
• DOI: 10.1093/ndt/gfu199

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). 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. 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). Our data suggest that the interplay between kidney and heart function begins prior to the development of symptomatic heart failure and kidney disease.