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Left ventricular hypertrophy predicts the decline of glomerular filtration rate in patients with type 2 diabetes mellitus

  • Nephrology - Original Paper
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Abstract

Purpose

The heart and kidney are of utmost importance for the maintenance of cardiovascular (CV) homeostasis. The relationship between cardiac remodeling, especially the left ventricular hypertrophy (LVH) and renal damage reflected by the estimated glomerular filtration rate (eGFR), decline in type 2 diabetes mellitus (T2DM) patients is unclear. And it is also unknown whether cardiac remodeling can be used to assess the eGFR decline in T2DM patients.

Methods

We retrospectively analyzed the relationship between cardiac remodeling especially the LVH and the eGFR decline for 265 patients with T2DM, who were diagnosed between 2011 and 2015 and followed for ≥ 3 months. The parameters of cardiac remodeling were determined using Doppler echocardiography.

Results

In the Cox regression model, the parameters of cardiac remodeling were associated with the composite endpoint in different models. These associations were independent of age, body mass index (BMI), history of hypertension, duration of diabetes, the baseline eGFR, 24-h urinary protein, or using angiotensin-converting enzyme inhibitors (ACEI) and (or) angiotensin receptor blockers (ARB). The risk of composite endpoint in patients with T2DM was higher (hazard ratio, 10.832; p < 0.001 for trend) in the group with the highest number of abnormal echocardiographic parameters, than in the group with no abnormal echocardiographic parameters. In receiver operating characteristics (ROC) curve analyses, the parameter of left ventricular posterior wall (LVPW) thickness was superior to the other parameters of cardiac remodeling as represented by the higher area under the curve (AUC) values generated according to the sensitivity and specificity.

Conclusion

Echocardiographic parameters are strongly correlated with the eGFR decline in patients with T2DM. Moreover, the severity of cardiac remodeling, especially the LVH is closely associated with the eGFR decline in patients with T2DM. Therefore, the recognition of cardiac structural alterations in patients with T2DM may evaluate renal damage at an early stage.

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Data availability

The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.

Abbreviations

T2DM:

Type 2 diabetes mellitus

LVH:

Left ventricular hypertrophy

UAER:

Urinary albumin excretion rate

eGFR:

Estimated glomerular filtration rate

LAD:

Left atrial diameter

LVDd:

Left ventricular diameter at the end of diastole

IVS:

Interventricular septum

LVPW:

Left ventricular posterior wall

TDE:

Two-dimensional echocardiography

ESRD:

End-stage renal disease

BMI:

Body mass index

Scr:

Serum creatinine

BUN:

Blood urea nitrogen

SUA:

Serum uric acid

TC:

Total cholesterol

TG:

Triglycerides

HDL:

High-density lipoprotein

LDL:

Low-density lipoprotein

HbA1c:

Glycosylated hemoglobin

BP:

Blood pressure

ROC:

Receiver operating characteristics

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Funding

This study was supported in part by the basic research project and technology development projects of Shenzhen Municipal Science and Technology Innovation Council (accounts JCYJ20130329104904512, JCYJ20151029154245758, CXZZ20140421155346007, and CXZZ20150601140615135) and the research project of Health and Family Planning Commission of Shenzhen Municipality (account SZFZ2018063).

Author information

Author notes

  1. Haiying Song and Haofei Hu have contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, The Affiliated Shenzhen Second People’s Hospital of Anhui Medical University, Shenzhen, 518035, Guangdong, China

    Haiying Song, Haofei Hu, Dehan Liao, Jinghong Wei, Cuimei Wei, Fupeng Liao, Wenxiong Zhou, Zihe Mo, Shilun Jiang & Yongcheng He

  2. Department of Nephrology, The First Affiliated Hospital of Shenzhen University, Shenzhen University Health Science Center, Shenzhen, 518035, Guangdong, China

    Haiying Song, Haofei Hu, Dehan Liao, Jinghong Wei, Cuimei Wei, Fupeng Liao, Wenxiong Zhou, Zihe Mo, Shilun Jiang & Yongcheng He

  3. Department of Nephrology, Shenzhen Second People’s Hospital, No. 3002 Sungang Road, Futian District, Shenzhen, 518035, Guangdong, China

    Haiying Song, Haofei Hu, Dehan Liao, Jinghong Wei, Cuimei Wei, Fupeng Liao, Wenxiong Zhou, Zihe Mo, Shilun Jiang & Yongcheng He

  4. Center for Nephrology, University College London, Rowland Hill Street, London, NW7 3SP, UK

    Xiongzhong Ruan

Authors
  1. Haiying Song
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  2. Haofei Hu
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  3. Dehan Liao
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  5. Cuimei Wei
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  6. Fupeng Liao
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  7. Wenxiong Zhou
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  8. Zihe Mo
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  9. Shilun Jiang
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  10. Xiongzhong Ruan
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  11. Yongcheng He
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Contributions

Yongcheng HE, Xiongzhong RUAN and Haiying SONG, and Haofei HU contributed to the study concept and design, researched, and interpreted the data and drafted the manuscript. Dehan LIAO and Jinghong WEI researched data and reviewed the manuscript. Cuimei WEI, Fupeng LIAO, Wenxiong ZHOU, Zihe MO, and Shilun JIANG oversaw the progress of the project, contributed to the discussion, and reviewed the manuscript. Yongcheng HE and Xiongzhong Ruan are the guarantors of this work and, as such, had full access to all the data in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors read and approved the final the manuscript.

Corresponding authors

Correspondence to Xiongzhong Ruan or Yongcheng He.

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Conflict of interest

The authors declare that they have no conflict of interests.

Ethics approval

The study was approved by the Clinical Research Ethical Committee of the Shenzhen Second People’s Hospital, and all patients provided fully informed consent.

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Song, H., Hu, H., Liao, D. et al. Left ventricular hypertrophy predicts the decline of glomerular filtration rate in patients with type 2 diabetes mellitus. Int Urol Nephrol 50, 2049–2059 (2018). https://doi.org/10.1007/s11255-018-1942-6

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  • DOI: https://doi.org/10.1007/s11255-018-1942-6

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