Trajectories of Kidney Function in Heart Failure Over a 15-Year Follow-Up: Clinical Profiling and Mortality,JACC: Heart Failure

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Trajectories of Kidney Function in Heart Failure Over a 15-Year Follow-Up: Clinical Profiling and Mortality
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2024-02-28 , DOI: 10.1016/j.jchf.2024.01.004
Elisabet Zamora ₁ , Pau Codina ₂ , Alberto Aimo ₃ , Josep Lupón ₁ , Mar Domingo ₄ , Maribel Troya ₅ , Evelyn Santiago-Vacas ₆ , Germán Cediel ₆ , Andrea Borrellas ₄ , María Ruiz-Cueto ₄ , Gregorio A Romero-González ₅ , Javier Santesmases ₂ , Julio Nuñez ₇ , Jordi Bover ₅ , Jordi Ara ₅ , Antoni Bayes-Genis ₁

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Limited data are available on the long-term trajectory of estimated glomerular filtration rate (eGFR) in patients with chronic heart failure. The authors evaluated eGFR dynamics using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation and its prognostic significance in a real-world cohort over a 15-year follow-up. A prospective observational registry of ambulatory heart failure outpatients was conducted, with regular eGFR assessments at baseline and on a 3-month schedule for ≤15 years. Urgent kidney function assessments were excluded. Locally weighted error sum of squares curves were plotted for predefined subgroups. Multivariable longitudinal Cox regression analyses were conducted to assess associations with all-cause and cardiovascular death. A total of 2,672 patients were enrolled consecutively between August 2001 and December 2021. The average age was 66.8 ± 12.6 years, and 69.8% were men. Among 40,970 creatinine measurements, 28,634 were used for eGFR analysis, averaging 10.7 ± 8.5 per patient. Over the study period, a significant decline in eGFR was observed in the entire cohort, with a slope of −1.70 mL/min/1.73 m per year (95% CI: −1.75 to −1.66 mL/min/1.73 m per year). Older patients, those with diabetes, a preserved ejection fraction, a higher baseline eGFR, elevated hospitalization rates, and those who died during follow-up experienced more pronounced decreases in the eGFR. Moreover, the decrease in kidney function correlated independently with all-cause mortality and cardiovascular death. These findings highlight the sustained decline in eGFR over 15 years in patients with heart failure, with variations based on clinical characteristics, and emphasize the importance of regular eGFR monitoring in this population.

中文翻译：

15 年随访期间心力衰竭肾功能轨迹：临床分析和死亡率

关于慢性心力衰竭患者估计肾小球滤过率（eGFR）的长期轨迹的数据有限。作者使用 2009 年慢性肾病流行病学协作方程评估了 eGFR 动态及其在 15 年随访的现实世界队列中的预后意义。对门诊心力衰竭患者进行了前瞻性观察登记，在基线时定期进行 eGFR 评估，每 3 个月进行一次，持续时间≤15 年。紧急肾功能评估被排除在外。为预定义的子组绘制了局部加权误差平方和曲线。进行多变量纵向 Cox 回归分析以评估与全因死亡和心血管死亡的关联。 2001年8月至2021年12月期间连续入组2,672名患者。平均年龄为66.8±12.6岁，其中69.8%为男性。在 40,970 次肌酐测量中，28,634 次用于 eGFR 分析，平均每位患者为 10.7 ± 8.5。在研究期间，整个队列的 eGFR 显着下降，斜率为每年 -1.70 mL/min/1.73 m（95% CI：每年 -1.75 至 -1.66 mL/min/1.73 m）。老年患者、糖尿病患者、射血分数保留、基线 eGFR 较高、住院率升高以及随访期间死亡的患者的 eGFR 下降更为明显。此外，肾功能下降与全因死亡率和心血管死亡独立相关。这些发现强调了心力衰竭患者的 eGFR 持续下降超过 15 年，并根据临床特征而变化，并强调了对该人群进行定期 eGFR 监测的重要性。

更新日期：2024-02-28

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