Reduced Estimated GFR and Cardiac Remodeling: A Population-Based Autopsy Study

Rationale & Objective Evidence suggests that cardiac remodeling, including left ventricular hypertrophy and myocardial fibrosis, develops with progression of kidney disease. Few studies have examined cardiac pathology across a range of estimated glomerular filtration rates (eGFRs), which was the objective of this investigation. Study Design Population-based cross-sectional study of deceased patients undergoing autopsy. Setting & Participants 334 of 694 consecutive deceased patients undergoing autopsy with available cardiac tissue, with a prior health examination within 6 years and without a prior diagnosis of heart disease. Exposure eGFR. Outcomes The thickness of the left ventricular wall, sizes of cardiac cells, and percentages of fibrosis, estimated from pathology examination of autopsy samples. Analytical Approach Generalized estimating equations. Results Lower eGFRs were associated with greater left ventricular wall thickness. Deceased patients with eGFRs≥60, 45 to 59, 30 to 44, and  2 had left ventricular wall thicknesses of 9.1, 9.5, 9.8, and 10.3mm, respectively ( P for trend 2 ( P for trend 2 ( P for trend Limitations Cross-sectional study with a high proportion of elderly patients, no available information for severity or duration of hypertension and other cardiovascular risk factors, no information for medication use. Conclusions These findings suggest that reduced eGFR is associated with cardiac hypertrophy and fibrosis of the left ventricle, cardiac cell enlargement, and cardiac fibrosis.