Chronic Kidney Disease, Heart Failure, and Adverse Cardiac Remodeling in Older Adults: The ARIC Study

Leo F. Buckley, Brian L. Claggett, Kunihiro Matsushita, Gearoid M. McMahon, Hicham Skali, Josef Coresh, Aaron R. Folsom, Suma H. Konety, Lynne E. Wagenknecht, Thomas H. Mosley, Amil M. Shah

Research output: Contribution to journalArticlepeer-review


Background: The associations of kidney dysfunction and damage with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF), as well as adverse cardiac remodeling, in late-life remain incompletely understood. Objectives: The authors sought to define the associations between kidney dysfunction and damage and incident HFrEF and HFpEF and cardiac structure and function in late-life. Methods: This study included 5,170 adults initially free of a heart failure (HF) diagnosis who had estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) measured at visit 5 (2011-2013) of the ARIC (Atherosclerosis Risk In Communities) study. Multivariable Cox proportional hazards models were used to estimate the associations of eGFR and UACR with incident HF, HFrEF, and HFpEF through 2019. Multivariable linear regression models were used to investigate the associations of eGFR and UACR at visit 5 with changes in cardiac structure and function between visits 5 and 7 in 2,313 participants with available echocardiograms. Results: The mean age of participants was 76 ± 5 years, and 2,225 (43%) were men. The mean eGFR and median UACR were 66 ± 18 mL/min/1.73 m2 and 11 mg/g (25th, 75th percentile: 6, 22 mg/g), respectively. In fully adjusted models, both lower eGFR and higher UACR were associated with greater risk of any HF, HFrEF, and HFpEF. Lower eGFR was associated with larger increases in left ventricular end-diastolic volume index and worsening of diastolic measures. UACR did not associate with changes in cardiac structure or function. Conclusions: Mild to moderate kidney dysfunction and damage associate with incident HF and adverse cardiac remodeling in late-life.

Original languageEnglish (US)
Pages (from-to)523-537
Number of pages15
JournalJACC: Heart Failure
Issue number5
StatePublished - May 2023


  • aging
  • chronic kidney disease
  • echocardiography
  • epidemiology
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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