Kidney Disease Markers Reflect Heart Failure Risk in African Americans

Data on kidney function and microalbuminuria are associated with the risk of congestive heart failure in an African American population, reports a study in Nephrology Dialysis Transplantation.

The researchers present data from 3332 African American participants enrolled in the community-based Jackson Heart Study. All were initially free of heart failure. Baseline measurements showed that 5% of participants had an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2, while 12% had a urine albumin:creatinine ratio (ACR) of 30 mg/g or higher. These kidney disease measures were evaluated for association with later subclinical evidence (based on echocardiography) or clinically assessed heart failure.

In adjusted models, both measures of kidney disease were associated with increased left ventricular mass (LVM): β-coefficient 1.54 per 10 mL/min/1.73 m2 decrease in eGFR and 2.87 per doubling of urine ACR. Neither measure was significantly associated with left ventricular ejection fraction.

The eGFR was unrelated to the risk of incident heart failure. However, urine ACR was related to clinical heart failure: hazard ratio 2.22 per doubling of urine ACR. This association was only slightly weakened by adjustment for left ventricular mass.

African American and other patients with chronic kidney disease are at high risk of heart failure. This study shows that eGFR and urine ACR are associated with increased LVM in an African American population. Urine ACR is associated with the development of clinical heart failure, even after adjustment for LVM. The mechanisms of these associations remain to be clarified [Bansal N, et al. Markers of kidney disease and risk of subclinical and clinical heart failure in African Americans: the Jackson Heart Study. Nephrol Dial Transpl 2016; 31:2057–2064].