Kidney function trajectories before and after hospitalization for heart failure with reduced ejection fraction

Area of Science:

• Cardiology
• Nephrology
• Clinical Trials Research

Background:

• Worsening kidney function is a critical prognostic indicator in heart failure with reduced ejection fraction (HFrEF).
• The precise relationship between kidney function trajectories and heart failure (HF)-related events requires further elucidation.

Purpose of the Study:

• To investigate the association between longitudinal changes in estimated glomerular filtration rate (eGFR) and HF-related events.
• To determine if kidney function decline precedes HF hospitalizations or death in patients with HFrEF.

Main Methods:

• Analysis of individual patient data from two clinical trials (EPHESUS, EMPHASIS-HF) and a real-world cohort (BARCELONA).
• Examination of longitudinal eGFR changes before and after HF-related events (hospitalization or death).
• Correlation of eGFR trajectories with New York Heart Association (NYHA) class.

Main Results:

• Patients experiencing HF-related events exhibited a significantly steeper eGFR decline in the year preceding the event compared to those without events.
• eGFR continued to decline post-event, albeit at a reduced rate.
• Worsening NYHA class was associated with accelerated eGFR decline prior to HF events.

Conclusions:

• Kidney function deterioration may precede HF hospitalizations or death by up to one year in HFrEF patients, potentially linked to symptomatic congestion.
• Monitoring the slope of eGFR, rather than fixed thresholds, may enable earlier identification of patients at high risk for adverse HF events.