International Journal of Medical Sciences

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23 October 2017

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Int J Med Sci 2013; 10(5):575-584. doi:10.7150/ijms.5845

Research Paper

Left Atrial Diameter and Albumin with Renal Outcomes in Chronic Kidney Disease

Szu-Chia Chen1,3,5, Jer-Ming Chang1,3,4, Yi-Chun Tsai1,3, Jiun-Chi Huang1,3, Ho-Ming Su2,3,5✉, Shang-Jyh Hwang1,4, Hung-Chun Chen1,4

1. Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
2. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;
3. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University;
4. Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
5. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Abstract

Background and Aim: Echocardiographic left atrial diameter (LAD) has been documented to be an independent predictor of adverse cardiovascular outcomes in various populations. An enlarged left atrium is frequently noted in chronic kidney disease (CKD). We examined the association between albumin and indexed LAD (indexed to height) and assessed whether the combination of indexed LAD and albumin was independently associated with renal outcomes in patients with CKD stages 3-5.

Methods: This longitudinal study enrolled 395 patients, who were classified into four groups according to median values of indexed LAD (LAD/height) and albumin. The change in renal function was measured by estimated glomerular filtration rate (eGFR) slope. Rapid renal progression was defined as eGFR slope less than -3 ml/min/1.73 m2/year. The renal end point was defined as commencement of dialysis.

Results: Albumin was significantly associated with indexed LAD (β = -0.108, P = 0.024). During follow-up period, seventy-four patients started dialysis. After the multivariate analysis, the group with higher indexed LAD and lower albumin was independently associated with rapid renal progression (odds ratio, 7.979; 95% confidence interval [CI], 3.028 to 21.025) and progression to dialysis (hazard ratio, 2.352; 95% CI, 1.078 to 5.131).

Conclusions: Our findings show that albumin is independently associated with indexed LAD and suggest that the combination of increased indexed LAD and hypoalbuminemia is independently associated with rapid renal progression and progression to dialysis in patients with CKD. Assessments of serum albumin and indexed LAD by echocardiography are useful for predicting the risk for adverse renal outcomes.

Keywords: indexed left atrial diameter, albumin, chronic kidney disease, renal function progression.

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How to cite this article:
Chen SC, Chang JM, Tsai YC, Huang JC, Su HM, Hwang SJ, Chen HC. Left Atrial Diameter and Albumin with Renal Outcomes in Chronic Kidney Disease. Int J Med Sci 2013; 10(5):575-584. doi:10.7150/ijms.5845. Available from http://www.medsci.org/v10p0575.htm