Abstract
The primary cause of death in chronic kidney disease (CKD) is cardiovascular disease. Life's Essential 8 (LE8) is an established measure of cardiovascular health. Our objective was to examine the relationship between cardiovascular health (LE8 score) and CKD progression among Hispanic/Latino adults, an understudied but growing population.
The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a longitudinal cohort of Hispanic/Latino adults aged 18-74 years from four cities in the United States, examined at visit 1 (V1, 2008-2011) and visit 2 (V2, 2014-2017). At V1, participants underwent a comprehensive assessment of health behaviors (diet, physical activity, nicotine exposure, sleep health) and clinical measurements (body mass index, blood lipids, blood glucose, blood pressure) used to estimate an LE8 score (range: 0 to 100). We included 1,284 participants with CKD at V1, defined as estimated GFR (eGFR) <60 ml/min/1.73 m2 and/or urine albumin-to-creatinine ratio (ACR) ≥30 mg/g. Change in eGFR and log(ACR) were defined as the difference in each measure between V1 and V2. To estimate the association between LE8 score with change in eGFR and log(ACR), we used linear regression models adjusted for follow-up time and demographic, socio-economic, and clinical factors. All analyses accounted for HCHS/SOL complex survey design.
Among 1284 Hispanic/Latino participants with CKD at V1, mean age was 48.6 years (Standard Error: 0.8), 57.2% were women, and mean LE8 score was 61.1 (Standard Error: 0.7). Over an average of six years of follow-up, eGFR declined by 5.8 ml/min/1.73 m2 and log(ACR) declined by 0.60. From multivariable adjusted models, for each 10-unit higher LE8 score, eGFR was lower by 0.97 ml/min/1.73 m2 less (95% CI: -1.93, -0.02) and log(ACR) was lower by an additional 0.15 (95% CI: 0.05, 0.25).
Among diverse US Hispanic/Latino adults with CKD, higher LE8 score (better cardiovascular health) was associated with a slower decline in eGFR and lower albuminuria over six years.