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. 2014 Feb 12;9(2):e88638.
doi: 10.1371/journal.pone.0088638. eCollection 2014.

Association of renal biochemical parameters with left ventricular diastolic dysfunction in a community-based elderly population in China: a cross-sectional study

Jingmin Zhou  1 , Xiaotong Cui  1 , Xuejuan Jin  1 , Jun Zhou  1 , Hanying Zhang  2 , Bixiao Tang  2 , Michael Fu  3 , Hans Herlitz  4 , Jie Cui  1 , Hongmin Zhu  1 , Aijun Sun  1 , Kai Hu  1 , Junbo Ge  1
Affiliations

Association of renal biochemical parameters with left ventricular diastolic dysfunction in a community-based elderly population in China: a cross-sectional study

Jingmin Zhou et al. PLoS One. .

Abstract

Background: Relationship of left ventricular diastolic dysfunction (LVDD) with parameters that could provide more information than hemodynamic renal indexes has not been clarified. We aimed to explore the association of comprehensive renal parameters with LVDD in a community-based elderly population.

Methods: 1,166 community residents (aged ≥ 65 years, 694 females) participating in the Shanghai Heart Health Study with complete data of renal parameters were investigated. Echocardiography was used to evaluate diastolic function with conventional and tissue Doppler imaging techniques. Serum urea, creatinine, urea-to-creatinine ratio, estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) were analyzed on their associations with LVDD.

Results: The prevalence of LVDD increased in proportion to increasing serum urea, urea-to-creatinine ratio and UACR. These three renal parameters were found negatively correlated to peak early (E) to late (A) diastolic velocities ratio (E/A), and positively to left atrial volume index; UACR also positively correlated with E to peak early (E') diastolic mitral annular velocity ratio (E/E'). Serum urea, urea-to-creatinine ratio and UACR correlated with LVDD in logistic univariate regression analysis, and urea-to-creatinine ratio remained independently correlated to LVDD [Odds ratio (OR) 2.82, 95% confidence interval (CI) 1.34-5.95] after adjustment. Serum urea (OR 1.18, 95%CI 1.03-1.34), creatinine (OR 6.53, 95%CI 1.70- -25.02), eGFR (OR 0.22, 95%CI 0.07-0.65) and UACR (OR 2.15, 95%CI 1.42-3.24) were revealed independent correlates of advanced (moderate and severe) LVDD.

Conclusions: Biochemical parameters of renal function were closely linked with LVDD. This finding described new cardio-renal relationship in the elderly population.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Prevalence of LVDD according to serum urea, urea-to-creatinine ratio, and UACR.
The prevalence of LVDD is 36.9%, 37.6% and 44.6% in tertile 1, 2 and 3 of serum urea respectively. It is 33.8%, 40.5% and 45.1% for urea-to-creatinine ratio and 35.1%, 39.7% and 44.5% for UACR, respectively. LVDD, left ventricular diastolic dysfunction; UACR, urinary albumin-to-creatinine ratio.
Figure 2
Figure 2. Relationship between serum urea and echocardiographic indexes (E/A and LAVI).
A) Serum urea was negatively correlated to E/A ratio. B) Serum urea was positively correlated to LAVI. LAVI, left atrial volume index.
Figure 3
Figure 3. Relationship between urea-to-creatinine ratio and echocardiographic indexes (E/A and LAVI).
A) Urea-to-creatinine ratio was negatively correlated to E/A ratio. B) Urea-to-creatinine ratio was positively correlated to LAVI. LAVI, left atrial volume index.
Figure 4
Figure 4. Relationship between UACR and echocardiographic indexes (E/A, E/E’ and LAVI).
A) UACR was negatively correlated to E/A ratio. B) UACR was positively correlated to LAVI. C) UACR was also positively correlated to E/E’ ratio. UACR, urinary albumin-to-creatinine ratio; LAVI, left atrial volume index.
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Grants and funding

This study is funded by grants from the Key Projects in the National Science & Technology Pillar Program in the Eleventh (2006BAI01A04) and Twelfth (2011BAI11B10) Five-year Plan Period of China, and the Exchange Program Fund of Doctoral Student under the Fudan University Graduate School. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.