Kidney Week

Abstract: SA-PO926

Association of suPAR, Galectin-3, and ST2 With CKD Progression in Heart Failure With Reduced Ejection Fraction

Session Information

• CKD: Observational Research and Patient-Oriented Interventions
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2202 CKD (Non-Dialysis): Clinical‚ Outcomes‚ and Trials

Authors

• Roehm, Bethany Angela, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Bethany Angela Roehm,

• Gordon, Jonathan, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Jonathan Gordon,

• McAdams, Meredith C., The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Meredith C. McAdams,

• Xu, Pin, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Pin Xu,

• Grodin, Justin, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Justin Grodin,

• Hedayati, Susan, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Susan Hedayati,

Background

Patients with heart failure with reduced ejection fraction (HFrEF) are at risk for CKD. Elevated levels of the circulating biomarkers soluble urokinase plasminogen activator receptor (suPAR), Galectin-3, and soluble suppression of tumorigenicity 2 (ST2) have been associated with a greater risk of CKD progression and mortality. However, little is known about the predictive value of these biomarkers in a population with HFrEF and kidney disease.

Methods

We aimed to determine whether these biomarkers could be used to predict decline in eGFR in HFrEF and whether they are associated with mortality using a joint longitudinal and cox regression model to account for competing risks of ventricular assist device (VAD) implantation and heart transplantation (OHT). We included 310 participants from the Registry Evaluation of Vital Information for Ventricular Assist Devices in Ambulatory Life with baseline biomarkers and repeated eGFR measures, followed for 2 years. The primary outcome was change in creatinine-based eGFR, adjusted for age, sex, race, diabetes mellitus, and NYHA class. Secondary outcome was mortality, adjusted for the same covariates and change in eGFR.

Results

Mean age was 59 years. Median eGFR was 60 ml/min/1.73m². Forty-five participants died, 33 received VAD, and 25 received OHT. Higher baseline plasma suPAR (β coefficient, -0.22 √(ml/min/1.73m²); P<0.001), Galectin-3 (-0.02 √(ml/min/1.73m²); P=0.012), and ST2 (-0.01 √(ml/min/1.73m²); P<0.001) were associated with a decline in eGFR. Only ST2 (HR 1.02 per ng/mL increase; P<0.001) was associated with mortality (Figure).

Conclusion

Higher baseline suPAR, Galectin-3, and ST2 were associated with a decrease in eGFR in patients with HFrEF. Only ST2 was associated with increased mortality. These biomarkers may provide prognostic value with regards to kidney disease in HFrEF and may help guide candidacy for potential advanced heart failure therapies.