The association of echocardiographic parameters on renal outcomes in chronic kidney disease

Figures & data

Table 1. Comparison of clinical characteristics between eGFR slope ≧ –3 and < –3 mL/min/1.73m²/yr.

Characteristics	All (n = 419)	eGFR slope ≧ –3 (n = 304)	eGFR slope < –3 (n = 115)	p
Age (year)	65.9 ± 12.3	67.0 ± 11.9	63.1 ± 13.0	.003
Male gender (%)	61.1	65.1	50.4	.006
Smoking (%)	30.5	29.6	33.0	.495
Diabetes mellitus (%)	56.6	49.3	75.7	<.001
Hypertension (%)	83.1	80.3	90.4	.013
Coronary artery disease (%)	11.2	8.9	17.4	.014
Systolic blood pressure (mmHg)	141.4 ± 21.1	138.7 ± 19.5	148.3 ± 23.5	<.001
Diastolic blood pressure (mmHg)	79.5 ± 12.8	79.2 ± 12.2	80.1 ± 14.3	.552
Laboratory parameters
Fasting glucose (mg/dL)	126.4 ± 57.7	119.8 ± 45.2	143.6 ± 79.6	.003
Triglyceride (mg/dL)	140.5 (96–200.75)	132 (90.5–191.5)	164 (118–240)	<.001
Total cholesterol (mg/dL)	194.5 ± 46.1	190.5 ± 43.6	205.1 ± 50.6	.004
Hemoglobin (g/dL)	11.7 ± 2.3	12.1 ± 2.3	10.7 ± 2.0	<.001
Baseline eGFR (mL/min/1.73m^2)	26.4 ± 14.1	29.3 ± 14.2	18.9 ± 10.7	<.001
Calcium-phosphorous product (mg^2/dL^2)	38.0 ± 8.6	37.2 ± 8.2	40.1 ± 9.1	.002
Echocardiographic parameters
LAD (cm)	3.7 ± 0.6	3.7 ± 0.6	4.0 ± 0.6	<.001
LAD ≧ 4.7 cm (%)	5.3	3.3	10.4	.003
LVM/BSA (g/m^2)	116.8 ± 36.6	112.0 ± 34.9	129.7 ± 37.9	<.001
LVM/BSA > 115 g/m^2 in male and > 95 g/m^2 in female (%)	56.6	49.7	74.8	<.001
LVM/ht^2.7 (g/ht^2.7)	55.0 ± 18.3	52.3 ± 17.3	62.0 ± 19.0	<.001
LVM/ht^2.7 > 48 g/ht^2.7 in male and > 44 g/ht^2.7 in female (%)	64.9	59.5	79.1	<.001
o/p LVM (%)	153.3 ± 49.6	148.3 ± 46.1	166.2 ± 55.7	.001
o/p LVM > 128% (%)	68.1	64.6	77.0	.016
LVEF (%)	69.2 ± 10.0	69.6 ± 9.9	68.1 ± 10.2	.171
LVEF < 50% (%)	4.1	3.9	4.3	.853
Outcome
eGFR slope (mL/min/1.73 m^2/yr)	–2.01 ± 0.15	–0.57 ± 0.09	–5.81 ± 0.27	<.001
Progression to dialysis (%)	39.6	27.0	73.0	<.001

eGFR: estimated glomerular filtration rate; LAD: left atrial dimension; LVM: left ventricular mass; BSA: body surface area; ht: height; o/p: observed/predicted; LVEF: left ventricular ejection fraction.

Figure 1. The estimated glomerular filtration rate (eGFR) slopes among (A) LAD < 4.7 cm vs. LAD ≧ 4.7 cm (p = .003); (B) LVM/BSA ≦ 115 g/m² in male and ≦ 95 g/m² in female vs. LVM/BSA > 115 g/m² in male and > 95 g/m² in female (p < .001); (C) LVM/ht^2.7 ≦ 48 g/ht^2.7 in male and ≦ 44 g/ht^2.7 in female vs. LVM/ht^2.7 > 48 g/ht^2.7 in male and > 44 g/ht^2.7 in female (p < .001); (D) o/p LVM ≦ 128% vs. o/p LVM > 128% (p = .022).

Table 2. Relation of echocardiographic parameters to eGFR slope using linear analysis.

Echocardiographic parameters	eGFR slope
	Unstandardized coefficient β (95% CI)	p
LAD (per 1 cm)
Unadjusted	–1.151 (–1.606, −0.697)	<.001
Age and gender adjusted	–1.177 (–1.624, −0.730)	<.001
Multivariate adjusted (1)	–0.897 (–1.352, −0.443)	<.001
Multivariate adjusted (2)	–0.736 (–1.187, −0.285)	.001
LVM/BSA (per 1 g/m^2)
Unadjusted	–0.020 (–0.027, −0.012)	<.001
Age and gender adjusted	–0.022 (–0.029, −0.014)	<.001
Multivariate adjusted (1)	–0.020 (–0.028, −0.012)	<.001
Multivariate adjusted (2)	–0.015 (–0.023, −0.007)	<.001
LVM/ht^2.7 (per 1 g/ht^2.7)
Unadjusted	–0.041 (–0.057, −0.025)	<.001
Age and gender adjusted	–0.042 (–0.058, −0.027)	<.001
Multivariate adjusted (1)	–0.039 (–0.055, −0.024)	<.001
Multivariate adjusted (2)	–0.029 (–0.045, −0.013)	<.001
o/p LVM (per 1%)
Unadjusted	–0.010 (–0.017, −0.004)	.001
Age and gender adjusted	–0.010 (–0.016, −0.004)	.001
Multivariate adjusted (1)	–0.009 (–0.014, −0.003)	.005
Multivariate adjusted (2)	–0.006 (–0.012, 0)	.036
LVEF (per 1%)
Unadjusted	0.033 (0.004, 0.062)	.028
Age and gender adjusted	0.031 (0.007, 0.054)	.011
Multivariate adjusted (1)	0.033 (0.005, 0.062)	.023
Multivariate adjusted (2)	0.023 (–0.006, 0.052)	.123

Values expressed as unstandardized coefficient β and 95% confidence interval (CI). Abbreviations are the same as in Table 1. Multivariate model 1: adjusted for age, gender, smoking, diabetes mellitus, hypertension and coronary artery disease. Multivariate model 2: adjusted for age, gender, smoking, diabetes mellitus, hypertension, coronary artery disease, systolic blood pressure ≧140 mmHg, fasting glucose, log-transformed triglyceride, total cholesterol, hemoglobin <12 g/dL, baseline eGFR <45 mL/min/1.73m² and calcium-phosphorous product.

Table 3. Relation of echocardiographic parameters to progression to dialysis using Cox proportional hazards model.

Echocardiographic parameters	Progression to dialysis
	Hazard ratio (95% CI)	p
LAD ≧ 4.7 cm
Unadjusted	2.544 (1.469–4.405)	.001
Age and gender adjusted	3.170 (1.807–5.562)	<.001
Multivariate adjusted (1)	3.059 (1.740–5.378)	<.001
Multivariate adjusted (2)	2.048 (1.115–3.760)	.021
LVM/BSA > 115 g/m^2 in male and > 95 g/m^2 in female
Unadjusted	2.351 (1.678–3.293)	<.001
Age and gender adjusted	2.160 (1.535–3.040)	<.001
Multivariate adjusted (1)	1.991 (1.406–2.821)	<.001
Multivariate adjusted (2)	1.547 (1.069–2.240)	.021
LVM/ht^2.7 > 48 g/ht^2.7 in male and > 44 g/ht^2.7 in female
Unadjusted	2.690 (1.832–3.948)	<.001
Age and gender adjusted	2.562 (1.743–3.767)	<.001
Multivariate adjusted (1)	2.323 (1.570–3.439)	<.001
Multivariate adjusted (2)	1.756 (1.157–2.665)	.008
o/p LVM > 128%
Unadjusted	1.639 (1.132–2.373)	<.001
Age and gender adjusted	1.578 (1.089–2.287)	.016
Multivariate adjusted (1)	1.459 (1.001–2.126)	.049
Multivariate adjusted (2)	1.362 (0.912–2.035)	.131
LVEF < 50%
Unadjusted	1.456 (0.682–3.109)	.331
Age and gender adjusted	1.738 (0.809–3.736)	.157
Multivariate adjusted (1)	1.683 (0.783–3.617)	.182
Multivariate adjusted (2)	0.835 (0.349–1.998)	.686

Values expressed as hazard ratio and 95% confidence interval (CI). Abbreviations are the same as in Table 1. Multivariate model 1: adjusted for age, gender, smoking, diabetes mellitus, hypertension and coronary artery disease. Multivariate model 2: adjusted for age, gender, smoking, diabetes mellitus, hypertension, coronary artery disease, systolic blood pressure > 140 mmHg, fasting glucose, log-transformed triglyceride, total cholesterol, hemoglobin <12 g/dL, baseline eGFR <45 mL/min/1.73m² and calcium-phosphorous product.

Figure 2. Kaplan-Meier analyses of dialysis-free survival among (A) LAD < 4.7 cm vs. LAD ≧ 4.7 cm (log-rank p = .001); (B) LVM/BSA ≦ 115 g/m² in male and ≦ 95 g/m² in female vs. LVM/BSA > 115 g/m² in male and > 95 g/m² in female (log-rank p < .001); (C) LVM/ht^2.7 ≦ 48 g/ht^2.7 in male and ≦ 44 g/ht^2.7 in female vs. LVM/ht^2.7 > 48 g/ht^2.7 in male and > 44 g/ht^2.7 in female (log-rank p < .001); (D) o/p LVM ≦ 128% vs. o/p LVM > 128% (log-rank p = .008).

Figure 3. Comparison of the prediction power of addition of echocardiographic parameters to a basic model in the prediction of progression to dialysis. Addition of LAD (p < .001), LVM/BSA (p = .024), and LVM/ht^2.7 (p = .030) resulted in a significant improvement in the prediction of progression to dialysis, but o/p LVM (p = .100) and LVEF (p = .164) did not.