Relation between Kidney Length and Cardiovascular and Renal Risk in High-Risk Patients

Clinical journal of the American Society of Nephrology: CJASN

Frank L.J. Visseren¹  Nicolette G.C. van der Sande²  Tim Leiner³  Gert Jan de Borst⁴  Peter J. Blankestijn⁵  Yolanda van der Graaf⁶ 

[1] Departments of *Vascular Medicine,..;Departments of *Vascular Medicine,..†Nephrology and Hypertension,..;¶Radiology, and..;‖Vascular Surgery, and..;†Nephrology and Hypertension,..;‡Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands..§Cardiology,..

关键词: cardiovascular disease;    end-stage renal disease;    kidney;    Biomarkers;    Body Surface Area;    Cardiovascular Diseases;    Cause of Death;    Follow-Up Studies;    Humans;    Kidney Failure, Chronic;    Linear Models;    Myocardial Infarction;    Reference Values;    Renal Insufficiency, Chronic;    risk factors;    Stroke;   

DOI  :  10.2215/CJN.08990816

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Kidney length is often measured during routine abdominal ultrasonography and may be of use to identify patients at high vascular and renal risk. We aimed to explore patient characteristics related to kidney length, from which reference values were derived, and evaluate the relationship between kidney length and the risk of cardiovascular events and ESRD in high-risk patients.Design, setting, participants, & measurements The study population consisted of 10,251 patients with clinical manifest arterial disease or vascular risk factors included in the Second Manifestations of ARTerial disease (SMART) Study cohort between 1996 and 2014. Linear regression was used to explore patient characteristics of kidney length. The relationship between kidney length and cardiovascular events (myocardial infarction, stroke, and cardiovascular mortality), all-cause mortality, and ESRD was analyzed using Cox regression. Kidney length was analyzed in tertiles, using the second tertile as the reference category.Results Kidney length was strongly correlated with body surface area (2.04 mm; 95% confidence interval [95% CI], 1.95 to 2.13 per 0.1 m2 increase) and eGFR (1.62 mm; 95% CI, 1.52 to 1.73 per 10 ml/min per 1.73 m2 increase). During the median follow-up of 6.3 years, 1317 patients experienced a cardiovascular event, including 711 myocardial infarctions, 369 strokes, and 735 vascular cause deaths. A total of 1462 patients died of any cause and 52 patients developed ESRD. Irrespective of eGFR, patients in the third tertile of kidney length (11.7–16.1 cm) were at higher risk of cardiovascular mortality (hazard ratio, 1.33; 95% CI, 1.05 to 1.67) and cardiovascular events (hazard ratio, 1.28; 95% CI, 1.09 to 1.50). Patients in the first tertile of kidney length (7.8–10.8 cm) were not at higher risk of cardiovascular adverse events.Conclusions Large kidney length is related to higher risk of cardiovascular events and mortality in high-risk patients, irrespective of eGFR. Kidney length may serve as a clinical marker to further identify patients at high cardiovascular risk.

【 授权许可】

CC BY