Kidney Week

Abstract: FR-PO083

Association of Acute eGFR Changes With Mortality and Heart Failure Hospitalizations Among Patients Admitted for Acute Heart Failure Requiring Hemodynamic Monitoring

Session Information

• AKI: Epidemiology, Risk Factors, Prevention
  November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

• Banlengchit, Run, Tufts Medical Center, Boston, Massachusetts, United States

Run Banlengchit,

• Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States

Hocine Tighiouart,

• Gillberg, Jake, Tufts Medical Center, Boston, Massachusetts, United States

Jake Gillberg,

• Tuttle, Marcelle, Tufts Medical Center, Boston, Massachusetts, United States

Marcelle Tuttle,

• Testani, Jeffrey M., Yale School of Medicine, New Haven, Connecticut, United States

Jeffrey M. Testani,

• Oka, Tatsufumi, Tufts Medical Center, Boston, Massachusetts, United States

Tatsufumi Oka,

• Kiernan, Michael S., Tufts Medical Center, Boston, Massachusetts, United States

Michael S. Kiernan,

• Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States

Mark J. Sarnak,

• McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States

Wendy I. McCallum,

Background

Acute changes in estimated glomerular filtration rate (eGFR) are frequently encountered among patients admitted for acute heart failure (AHF). However, there is wide variation in how acute eGFR change is described, and whether these acute changes are associated with clinical outcomes.

Methods

Records for patients admitted with a primary diagnosis of AHF requiring invasive hemodynamic monitoring were collected from 2015 to 2021 from a single quaternary academic center. Using the CKD-EPI 2021 formula, each in-hospital creatinine was used to estimate GFR, and slopes of eGFR were calculated for each individual using linear mixed modeling. Multivariable Cox regression models were used to evaluate the association between in-hospital eGFR slope with risk of mortality and a composite of mortality or HF hospitalization after discharge, treating eGFR slope both as a continuous variable and in quartile analysis. Covariates included age, sex, race, diabetes, hypertension, and baseline eGFR.

Results

Among 727 patients admitted for AHF with both baseline and discharge eGFR available, the mean (SD) age was 61 (14) years with mean baseline eGFR of 57 (27) ml/min/1.73m². Overall, eGFR increased by median (IQR) 1.3 ml/min/1.73m² per week (-1.5, 4.6). Over a median 14 (maximum 35) months follow-up, in reference to the quartile with the fastest increase in eGFR (Quartile 1), the quartile with fastest decline in eGFR (Quartile 4) was associated with increased risk of mortality and composite of mortality and HF hospitalization (Table).

Conclusion

Among patients admitted for AHF requiring invasive hemodynamic monitoring, an acute in-hospital decrease in eGFR was associated with increased risk of mortality and heart failure hospitalization, independent of baseline eGFR.

Funding

• Other NIH Support