Kidney Week

Abstract: FR-PO091

Timing of Acute eGFR Declines in Acute Heart Failure and Their Association with Cardiovascular and Kidney Outcomes

Session Information

• AKI: Diagnosis and Outcomes
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

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

Wendy I. McCallum, MD, MS

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

Hocine Tighiouart, MS

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

Marcelle Tuttle, MD

• Lala-Trindade, Anuradha, Icahn School of Medicine at Mount Sinai, New York, New York, United States

Anuradha Lala-Trindade, MD

• Costanzo, Maria Rosa, Midwest Cardiovascular Institute, Naperville, Illinois, United States

Maria Rosa Costanzo, MD

• Bautista, Isabel Victoria, Yale University School of Medicine, New Haven, Connecticut, United States

Isabel Victoria Bautista

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

Tatsufumi Oka, MD, PhD

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

Jeffrey M. Testani, MD

• Konstam, Marvin, Tufts Medical Center, Boston, Massachusetts, United States

Marvin Konstam

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

Mark J. Sarnak, MD, MS

Background

The association of declines in estimated glomerular filtration rate (eGFR) with cardiovascular and kidney outcomes in patients with acute heart failure (AHF) have been inconsistent, perhaps due to differences in assessment of timing of the decline.

Methods

Using data from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial, we used multivariable Cox regression models to evaluate the association between declines in eGFR at 48-hours after randomization, at hospital discharge and at 14-days after randomization with all-cause mortality, a composite of cardiovascular (CV) mortality and heart failure (HF) hospitalization, as well as with longer term kidney outcomes including eGFR decline by >40% and incident chronic kidney disease (CKD) Stage ≥4.

Results

Among 3931 patients over a median follow-up of 9.9 months, eGFR decline at 48-hours was not associated with mortality (aHR=0.96 [95% CI 0.85, 1.10] per 30% eGFR decline) or with the composite outcome of CV mortality or HF hospitalization (HR=0.95 [0.86, 1.06]), with similar results for eGFR decline at discharge. In contrast, eGFR decline at 14-days was associated with higher risk of mortality (aHR=1.32 [1.20, 1.46] per 30% eGFR decline) and the composite outcome (HR=1.19 [1.10, 1.29]). eGFR declines at the 48-hour, discharge and 14-day time points were associated with significantly higher risk of eGFR decline by >40% and incident CKD Stage ≥4 (Figure).

Conclusion

Among patients admitted for AHF, incorporating timing of acute declines in eGFR is pivotal for interpreting prognostic importance from the cardiovascular standpoint. In contrast, declines in eGFR at all time points are associated with worse longer term kidney function.

Figure. Adjusted hazard ratios for incident CKD Stage ≥4 based on three different time points of acute decline in eGFR: 48-hours after randomization, at the time of discharge, and 14-days following randomization. Hazard ratios displayed per 30% decline in eGFR.

Funding

• NIDDK Support