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Prognosis After >50% Decline in eGFR in Heart Failure Patients: A Nationwide Real-World Study
Deewa Zahir Anjum1, Mariam Elmegaard1, Caroline Hartwell Garred1
1Department of Cardiology, Copenhagen University Hospital, Hellerup, Denmark.
Insights
A significant decline in estimated glomerular filtration rate (eGFR) after heart failure diagnosis increases mortality and end-stage kidney disease (ESKD) risk. This risk is elevated regardless of diabetes status, highlighting eGFR
Area of Science:
- Nephrology
- Cardiology
- Clinical Epidemiology
Background:
- A 50% decline in estimated glomerular filtration rate (eGFR) is a novel kidney endpoint in heart failure (HF) trials.
- The prognostic value of this eGFR decline beyond 6 months post-diagnosis, especially in non-diabetic patients, requires further investigation.
Purpose of the Study:
- To assess the long-term prognostic implications of eGFR decline on all-cause mortality and end-stage kidney disease (ESKD) in heart failure patients.
- To evaluate these risks in relation to diabetes status.
Main Methods:
- Nationwide cohort study of new-onset heart failure patients (2014-2021).
- eGFR trajectory assessed from 6 to 12 months post-diagnosis into stable, 25%-50% decline, and >50% decline groups.
- Landmark analysis included patients surviving the first year, focusing on all-cause mortality and ESKD.
Main Results:
- Among 45,385 HF patients, 3.3% experienced >50% eGFR decline by 1 year.
- In non-diabetic patients, >25% eGFR decline significantly increased 5-year mortality risk.
- Both mortality and ESKD risks escalated with greater eGFR decline, with higher absolute risks observed in diabetic patients.
Conclusions:
- A >50% eGFR decline is a significant predictor of increased mortality and ESKD risk in heart failure patients.
- This association holds true irrespective of diabetes status, confirming its clinical importance.
Background:
A 50% decline in estimated glomerular filtration rate (eGFR) has been introduced as a new kidney endpoint in heart failure (HF) trials. However, its prognostic significance beyond the initial 6 months following HF diagnosis, during which patients often undergo medical therapy optimization, remains uncertain-particularly for patients without diabetes.
Objectives:
This study aims to determine the long-term prognostic implications of eGFR decline focusing on risks for all-cause mortality and end-stage kidney disease (ESKD).
Methods:
The authors conducted a nationwide cohort study of all new-onset patients diagnosed with HF between 2014 and 2021. eGFR trajectory was assessed from months 6 to 12 post-diagnosis categorizing patients into 3 groups: stable eGFR (<25% decline), 25%-50% decline, and >50% decline. Only patients who survived the first year post-diagnosis were included in the landmark analysis with the primary outcomes of all-cause mortality and ESKD.
Results:
Among 45,385 patients with HF (median age: 73.6, 63.8% male), 82.5% had stable eGFR, 14.2% had a 25%-50% decline, and 3.3% had >50% decline at 1 year. In patients without diabetes, eGFR decline >25% was associated with increased 5-year mortality, with absolute risks of 33.2%, 53.8%, and 63.0% for stable eGFR, 25%-50% decline, and >50% decline, respectively. In patients with diabetes, absolute mortality risk was generally higher but followed the same trend (42.8%, 58.6%, and 65.6% for stable eGFR, 25%-50% decline, and >50% decline, respectively). The risk of developing ESKD also increased with eGFR decline. In patients without diabetes, absolute risks were 3.3%, 7.9%, and 11.5% for stable eGFR, 25%-50% decline, and >50% decline, respectively, whereas the absolute risk of ESKD was notably higher in patients with diabetes (7.4%, 15.6%, and 21.1% for stable eGFR, 25%-50% decline, and >50% decline, respectively).
Conclusions:
In this large real-world study, a >50% eGFR decline was associated with increased mortality and ESKD risk irrespective of diabetes status, underscoring its clinical relevance.
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