Kidney Week

Abstract: FR-PO356

Cystatin C-based eGFR Predicts Patient-Reported Outcomes in Heart Failure

Session Information

• Hypertension, CVD, and the Kidneys: Epidemiology
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Lackey, Blake Neal, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Blake Neal Lackey, MD

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

Bethany Angela Roehm, MD, MS

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

Justin Grodin, MD, MPH

• Hedayati, Susan, Stony Brook University Hospital, Stony Brook, New York, United States

Susan Hedayati, MD, MS, MSc, FASN

Background

Lower eGFR is linked to worse outcomes in people with heart failure (HF) with reduced (HFrEF) and preserved (HFpEF) ejection fractions. Data on patient-reported outcomes (PROs) in HF and eGFR using Cr (GFRcr) are conflicted and scarce using cystatin C (GFRCys).

Methods

We tested the association between baseline eGFR and the Kansas City Cardiomyopathy Questionnaire (KCCQ), Minnesota Living with Heart Failure Questionnaire (MLHFQ), and 6 min walk test (6MWT) at baseline and 6 mo in 769 participants of EXACT-HF (n=253), RELAX (n=216), and FIGHT (n=300) trials. eGFR measures used were GFRcr, GFRcys, a weighted average of both (GFRcr-cys), and GFRcys/GFRcr<0.7, a predictor of mortality in HFrEF and CKD. Linear regression was used, adjusting for age, sex, diabetes, BMI, NYHA class, NT-proBNP, and treatment arm.

Results

Mean (SD) age was 63 (13). 28% were female, 59% had NYHA class 3-4 symptoms, 72% HFrEF, and 20% GFRcys/GFRcr <0.7. Mean GFRcr was 58 (23), GFRcys 54 (25), and GFRcr-cys 57 (24) ml/min/1.73m2. All GFR measures were associated with 6MWT at baseline. Only Cys-derived measures associated with 6MWT at 6 mo in multivariable analyses. GFRcys/GFRcr <0.7 predicted a drop in 6MWT distance by nearly 35 m at 6 mo. All cys-based eGFR associated with KCCQ at 6 mo but not with MLHFQ in multivariable analyses (Table).

Conclusion

GFR estimates using cystatin C but not Cr predicted worse performance on 6MWT and KCCQ in people in HF. No GFR measures predicted MLHFQ score, indicative of MLHFQ’s known lower sensitivity to change. These findings offer new insights on the adverse effects of declining kidney function on HF symptoms. More research is needed on the validity of GFRcys as a measure of frailty in HF.