Chronic kidney disease and incident heart failure: insights from the Atherosclerosis Risk in Communities study

The ARIC (Atherosclerosis Risk in Communities) study is a large US cohort study that enrolled over 15,000 adults aged 45–64 years, originally aiming to understand drivers of atherosclerotic cardiovascular disease. Included amongst the ARIC study visits were measurement of estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR) and serial transthoracic echocardiography. 

In a recent analysis of 5170 subjects from the ARIC cohort (mean age 76±5 years; 45% males; mean eGFR 66±18 mL/min /1.73 m²; median UACR 11 [6, 22] mg/g) free of baseline heart failure and with available paired renal function and cardiac imaging data, Buckley and colleagues aimed to identify associations between kidney disease, cardiac remodelling and downstream incident heart failure (either with reduced ejection fraction [HFrEF] or preserved ejection fraction [HFpEF]). In fully adjusted models, both lower eGFR and higher UACR were independently associated with greater risk of HFrEF and HFpEF. However, only lower eGFR was associated with increases in left ventricular end-diastolic volumes and worsening of diastolic function, whereas UACR was not associated with measured changes in cardiac structure or function.

These findings indicate that adults with markers of mild to moderate kidney disease have an increased risk of incident heart failure, independent of other risk factors, with variable effects on cardiac remodelling. The authors suggested that eGFR or UACR measurements can be used to potentially identify older adults who may benefit from novel cardiorenal therapies.

The full study can be read here.