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Changes in Kidney Function After Diagnosis of Advanced Heart Failure
Benjamin J Quiram1, Jill M Killian2, Margaret M Redfield3
1Mayo Clinic Alix School of Medicine, Rochester, Minnesota.
Journal of Cardiac Failure
|July 14, 2023
Summary
Kidney function declines faster in advanced heart failure (HF) patients. Lower estimated glomerular filtration rate (eGFR) at diagnosis is linked to worse survival in advanced HF.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- The relationship between kidney function and outcomes in advanced heart failure (HF) is not well-defined.
- Understanding this association is crucial for managing complex HF patients.
Purpose of the Study:
- To investigate the association between estimated glomerular filtration rate (eGFR) and outcomes in patients with advanced heart failure.
- To analyze the longitudinal eGFR trajectory in relation to advanced HF development.
Main Methods:
- Retrospective cohort study of adult residents in Olmsted County, Minnesota (2007-2017).
- Patients were grouped by eGFR at advanced HF diagnosis using the CKDEpi 2021 equation.
- A linear mixed effects model assessed eGFR trajectory and advanced HF development.
Main Results:
- 936 patients with advanced HF were included (mean age 77, 55% male).
- 22% had eGFR <30 mL/min/1.73 m² at diagnosis; 32% had eGFR ≥60 mL/min/1.73 m².
- eGFR declined faster after advanced HF diagnosis (10.9% annual decline vs 7.6% before).
- Lower eGFR (<30 mL/min/1.73 m²) was associated with worse survival (aHR 1.30).
Conclusions:
- Kidney function, specifically eGFR, deteriorates more rapidly after the development of advanced HF.
- An eGFR <30 mL/min/1.73 m² at advanced HF diagnosis is a significant predictor of higher mortality.
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