Reduced Estimated GFR and Cardiac Remodeling

A Population-Based Autopsy Study

Kensuke Izumaru, Jun Hata, Toshiaki Nakano, Yutaka Nakashima, Masaharu Nagata, Masayo Fukuhara, Yoshinao Oda, Takanari Kitazono, Toshiharu Ninomiya

研究成果: ジャーナルへの寄稿記事

抄録

Rationale & Objective: Evidence suggests that cardiac remodeling, including left ventricular hypertrophy and myocardial fibrosis, develops with progression of kidney disease. Few studies have examined cardiac pathology across a range of estimated glomerular filtration rates (eGFRs), which was the objective of this investigation. Study Design: Population-based cross-sectional study of deceased patients undergoing autopsy. Setting & Participants: 334 of 694 consecutive deceased patients undergoing autopsy with available cardiac tissue, with a prior health examination within 6 years and without a prior diagnosis of heart disease. Exposure: eGFR. Outcomes: The thickness of the left ventricular wall, sizes of cardiac cells, and percentages of fibrosis, estimated from pathology examination of autopsy samples. Analytical Approach: Generalized estimating equations. Results: Lower eGFRs were associated with greater left ventricular wall thickness. Deceased patients with eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 had left ventricular wall thicknesses of 9.1, 9.5, 9.8, and 10.3 mm, respectively (P for trend < 0.05). Lower eGFRs were also significantly associated with greater mean values of cardiac cell size in the left ventricular wall after adjusting for confounders: 15.3, 16.1, 16.4, and 17.4 μm for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 (P for trend < 0.01). Patients with lower eGFRs had significantly higher multivariable-adjusted geometric mean values for fibrosis percentage in the left ventricular wall: 3.22%, 4.33%, 3.83%, and 6.14% for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 (P for trend < 0.001). The negative association of eGFR with multivariable-adjusted mean values of cardiac cell width was stronger among patients with than those without anemia. Limitations: Cross-sectional study with a high proportion of elderly patients, no available information for severity or duration of hypertension and other cardiovascular risk factors, no information for medication use. Conclusions: These findings suggest that reduced eGFR is associated with cardiac hypertrophy and fibrosis of the left ventricle, cardiac cell enlargement, and cardiac fibrosis.

元の言語英語
ジャーナルAmerican Journal of Kidney Diseases
DOI
出版物ステータス出版済み - 1 1 2019

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Glomerular Filtration Rate
Autopsy
Population
Fibrosis
Cell Size
Cross-Sectional Studies
Cell Enlargement
Pathology
Kidney Diseases
Cardiomegaly
Left Ventricular Hypertrophy
Heart Ventricles
Anemia
Heart Diseases
Hypertension
Health

All Science Journal Classification (ASJC) codes

  • Nephrology

これを引用

Reduced Estimated GFR and Cardiac Remodeling : A Population-Based Autopsy Study. / Izumaru, Kensuke; Hata, Jun; Nakano, Toshiaki; Nakashima, Yutaka; Nagata, Masaharu; Fukuhara, Masayo; Oda, Yoshinao; Kitazono, Takanari; Ninomiya, Toshiharu.

:: American Journal of Kidney Diseases, 01.01.2019.

研究成果: ジャーナルへの寄稿記事

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title = "Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study",
abstract = "Rationale & Objective: Evidence suggests that cardiac remodeling, including left ventricular hypertrophy and myocardial fibrosis, develops with progression of kidney disease. Few studies have examined cardiac pathology across a range of estimated glomerular filtration rates (eGFRs), which was the objective of this investigation. Study Design: Population-based cross-sectional study of deceased patients undergoing autopsy. Setting & Participants: 334 of 694 consecutive deceased patients undergoing autopsy with available cardiac tissue, with a prior health examination within 6 years and without a prior diagnosis of heart disease. Exposure: eGFR. Outcomes: The thickness of the left ventricular wall, sizes of cardiac cells, and percentages of fibrosis, estimated from pathology examination of autopsy samples. Analytical Approach: Generalized estimating equations. Results: Lower eGFRs were associated with greater left ventricular wall thickness. Deceased patients with eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 had left ventricular wall thicknesses of 9.1, 9.5, 9.8, and 10.3 mm, respectively (P for trend < 0.05). Lower eGFRs were also significantly associated with greater mean values of cardiac cell size in the left ventricular wall after adjusting for confounders: 15.3, 16.1, 16.4, and 17.4 μm for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 (P for trend < 0.01). Patients with lower eGFRs had significantly higher multivariable-adjusted geometric mean values for fibrosis percentage in the left ventricular wall: 3.22{\%}, 4.33{\%}, 3.83{\%}, and 6.14{\%} for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 (P for trend < 0.001). The negative association of eGFR with multivariable-adjusted mean values of cardiac cell width was stronger among patients with than those without anemia. Limitations: Cross-sectional study with a high proportion of elderly patients, no available information for severity or duration of hypertension and other cardiovascular risk factors, no information for medication use. Conclusions: These findings suggest that reduced eGFR is associated with cardiac hypertrophy and fibrosis of the left ventricle, cardiac cell enlargement, and cardiac fibrosis.",
author = "Kensuke Izumaru and Jun Hata and Toshiaki Nakano and Yutaka Nakashima and Masaharu Nagata and Masayo Fukuhara and Yoshinao Oda and Takanari Kitazono and Toshiharu Ninomiya",
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TY - JOUR

T1 - Reduced Estimated GFR and Cardiac Remodeling

T2 - A Population-Based Autopsy Study

AU - Izumaru, Kensuke

AU - Hata, Jun

AU - Nakano, Toshiaki

AU - Nakashima, Yutaka

AU - Nagata, Masaharu

AU - Fukuhara, Masayo

AU - Oda, Yoshinao

AU - Kitazono, Takanari

AU - Ninomiya, Toshiharu

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Rationale & Objective: Evidence suggests that cardiac remodeling, including left ventricular hypertrophy and myocardial fibrosis, develops with progression of kidney disease. Few studies have examined cardiac pathology across a range of estimated glomerular filtration rates (eGFRs), which was the objective of this investigation. Study Design: Population-based cross-sectional study of deceased patients undergoing autopsy. Setting & Participants: 334 of 694 consecutive deceased patients undergoing autopsy with available cardiac tissue, with a prior health examination within 6 years and without a prior diagnosis of heart disease. Exposure: eGFR. Outcomes: The thickness of the left ventricular wall, sizes of cardiac cells, and percentages of fibrosis, estimated from pathology examination of autopsy samples. Analytical Approach: Generalized estimating equations. Results: Lower eGFRs were associated with greater left ventricular wall thickness. Deceased patients with eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 had left ventricular wall thicknesses of 9.1, 9.5, 9.8, and 10.3 mm, respectively (P for trend < 0.05). Lower eGFRs were also significantly associated with greater mean values of cardiac cell size in the left ventricular wall after adjusting for confounders: 15.3, 16.1, 16.4, and 17.4 μm for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 (P for trend < 0.01). Patients with lower eGFRs had significantly higher multivariable-adjusted geometric mean values for fibrosis percentage in the left ventricular wall: 3.22%, 4.33%, 3.83%, and 6.14% for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 (P for trend < 0.001). The negative association of eGFR with multivariable-adjusted mean values of cardiac cell width was stronger among patients with than those without anemia. Limitations: Cross-sectional study with a high proportion of elderly patients, no available information for severity or duration of hypertension and other cardiovascular risk factors, no information for medication use. Conclusions: These findings suggest that reduced eGFR is associated with cardiac hypertrophy and fibrosis of the left ventricle, cardiac cell enlargement, and cardiac fibrosis.

AB - Rationale & Objective: Evidence suggests that cardiac remodeling, including left ventricular hypertrophy and myocardial fibrosis, develops with progression of kidney disease. Few studies have examined cardiac pathology across a range of estimated glomerular filtration rates (eGFRs), which was the objective of this investigation. Study Design: Population-based cross-sectional study of deceased patients undergoing autopsy. Setting & Participants: 334 of 694 consecutive deceased patients undergoing autopsy with available cardiac tissue, with a prior health examination within 6 years and without a prior diagnosis of heart disease. Exposure: eGFR. Outcomes: The thickness of the left ventricular wall, sizes of cardiac cells, and percentages of fibrosis, estimated from pathology examination of autopsy samples. Analytical Approach: Generalized estimating equations. Results: Lower eGFRs were associated with greater left ventricular wall thickness. Deceased patients with eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 had left ventricular wall thicknesses of 9.1, 9.5, 9.8, and 10.3 mm, respectively (P for trend < 0.05). Lower eGFRs were also significantly associated with greater mean values of cardiac cell size in the left ventricular wall after adjusting for confounders: 15.3, 16.1, 16.4, and 17.4 μm for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 (P for trend < 0.01). Patients with lower eGFRs had significantly higher multivariable-adjusted geometric mean values for fibrosis percentage in the left ventricular wall: 3.22%, 4.33%, 3.83%, and 6.14% for eGFRs ≥ 60, 45 to 59, 30 to 44, and <30 mL/min/1.73 m 2 (P for trend < 0.001). The negative association of eGFR with multivariable-adjusted mean values of cardiac cell width was stronger among patients with than those without anemia. Limitations: Cross-sectional study with a high proportion of elderly patients, no available information for severity or duration of hypertension and other cardiovascular risk factors, no information for medication use. Conclusions: These findings suggest that reduced eGFR is associated with cardiac hypertrophy and fibrosis of the left ventricle, cardiac cell enlargement, and cardiac fibrosis.

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