The Association Of Cardiac Valvular Abnormality With Prevalent And Incident Chronic Kidney Disease In Community-Dwelling Older Adults: The Atherosclerosis Risk In Communities Study

Background: An improvement in kidney function has been reported after percutaneous valvular replacement therapies, implying pathophysiological contribution of valvular heart disease to chronic kidney disease (CKD). However, this association has not been investigated in community dwelling populations. Hypothesis: Valvular abnormality is associated with prevalent and incident CKD. Methods: We evaluated the association between valvular abnormality and prevalent CKD (primarily defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73m 2 ) in 5,216 participants (mean age 75.5 [SD 5.1] years) from the ARIC study (2011-2013) using logistic regression. Then, 3,752 participants without prevalent CKD were analyzed for incident CKD (progression to eGFR <60 mL/min/1.73m 2 with ≥25% decline or hospitalization/deaths with CKD diagnosis) using Cox models. Valvular abnormality included echocardiography-based aortic stenosis (AS), aortic regurgitation (AR), and mitral regurgitation (MR). Results: There were 1.4% (n=74) with any AS, 10.6% (n=555) with any AR, and 43.1% (n=2,249) with any MR. The majority (57-96%) had mild or trace abnormality. After adjustment for potential confounders, any MR and moderate/severe AR showed significant associations with prevalent CKD (adjusted odds ratio 1.17 [95% CI 1.03-1.34] and 2.82 [1.12-7.10]), as did any AS in a sensitivity analysis with prevalent CKD defined including albuminuria ≥30 mg/g (1.83 [1.10-3.05]). Only any AS showed an independent association with incident CKD (adjusted hazard ratio: 2.12 [1.13-4.00]). The 5-year cumulative incidence of CKD was 17.3% in any AS and 7.4% in no AS (Figure). Conclusions: Different types of valvular abnormality were associated with prevalent CKD. Prospectively, only AS was associated with incident CKD. These findings suggest an etiological link between valvular abnormality and CKD and highlight the importance of clinical attention to kidney function in individuals with AS.