Cardiac Valve Disease and Prevalent and Incident CKD in Community-Dwelling Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Rationale & Objective: Recent literature suggests improvement in kidney function after percutaneous valvular replacement therapies, implying a patho-physiological contribution of valvular heart disease to chronic kidney disease (CKD). However, this association has not been investigated epidemio-logically. We aimed to assess the association of valvular abnormality with prevalent and incident CKD. Study Design: Cross-sectional and prospective analyses.Setting & Participants: Community-dwelling par-ticipants (mean age 75.5 [standard deviation 5.1] years) from the Atherosclerosis Risk in Commu-nities study (2011-2013). Exposure: Valvular abnormality defined as echocardiography-based aortic stenosis, aortic regurgitation, and mitral regurgitation.Outcomes: Prevalent CKD was defined as esti-mated glomerular filtration rate (eGFR]) <60 mL/ min/1.73 m2. Incident CKD was defined as pro-gression to eGFR <60 mL/min/1.73 m2 with >= 25% decline or hospitalization/deaths with CKD diagnosis.Analytical Approach: We cross-sectionally evaluated the association between valvular abnormality and prevalent CKD with logistic regression in 5,216 participants. Then, 3,752 participants without prevalent CKD were analyzed for incident CKD using Cox models.Results: There were 1.4% (n = 74) with any aortic stenosis, 10.6% (n = 555) with any aortic regurgi-tation, and 43.1% (n = 2,249) with any mitral regurgitation. After adjustment for potential con-founders, any mitral regurgitation and moderate/ severe aortic regurgitation showed significant as-sociations with prevalent CKD (adjusted OR, 1.17 [95% CI, 1.03-1.3 4] and 2.82 [95% CI, 1.12-7.10]), as did any aortic stenosis in a sensitivity analysis with prevalent CKD defined including albuminuria >= 30 mg/g (1.83 [95% CI, 1.10-3.05]). Only any aortic stenosis showed an independent association with incident CKD (adjusted HR, 2.12 [95% CI, 1.13-4.00]).Limitations: Despite a relatively large study pop-ulation, some subgroups had small numbers. Although we minimized reverse causation, we cannot completely rule it out.Conclusions: Different valvular abnormality types were associated with prevalent CKD. Only aortic stenosis was robustly associated with incident CKD. These findings suggest an etiological link between valvular abnormality and CKD, high-lighting the importance of clinical attention to kid-ney function in individuals with aortic stenosis.