Effects of a reduction in renal function on cardiovascular structure and function: a prospective study of living kidney donors

Chronic kidney disease (CKD) is highly prevalent and recognised as a global public health problem. It has been consistently associated with hypertension and cardiovascular disease; many more patients with a glomerular filtration rate (GFR) below 60 ml/min/1.73m2 die from cardiovascular causes than progress to end-stage renal disease. Nevertheless, observational studies of cardiovascular disease in CKD remain hard to interpret because renal impairment is forever accompanied by residual confounding factors. These may include the underlying disease process (e.g. diabetes mellitus), or the complications of CKD, such as hypertension, anaemia, bone mineral disease and inflammation. The prospective study of living kidney donors presented in this work provided an ideal experimental model to assess the longitudinal effects of reduced renal function in healthy subjects without manifest cardiovascular disease. Compared with healthy controls, the modest reduction in GFR in donors accompanying uninephrectomy caused increased left ventricular (LV) mass, LV dysfunction, and increased aortic stiffness. There was no change in blood pressure but there were increases in parathyroid hormone, uric acid and highly sensitive C-reactive protein. The size of the reduction in GFR independently predicted the extent of adverse LV remodelling. Reduced GFR should therefore be regarded as a causative risk factor for LV disease and increased arterial stiffness