Abstract: TH-PO484

Renal and Overall Survival (OS) in Type 5 Cardiorenal Syndrome in Systemic AL Amyloidosis Is Dictated by Cardiac Response at 12 Months

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Rezk, Tamer, UCL Division of Medicine, London, United Kingdom
  • Lachmann, Helen J., National Amyloidosis Centre, London, United Kingdom
  • Whelan, Carol, National Amyloidosis centre, UCL, London, United Kingdom
  • Wechalekar, Ashutosh, National Amyloidosis Centre, London, United Kingdom
  • Hawkins, Philip N., National Amyloidosis Centre, London, United Kingdom
  • Gillmore, Julian D., National Amyloidosis Centre, London, United Kingdom
Background

Systemic AL amyloidosis is a progressive, fatal disease that is a cause of Type 5 cardiorenal syndrome. Renal involvement leading to ESRD is the main determinant of morbidity and cardiac involvement the main determinant of mortality. Current consensus is that renal progression (reduction in eGFR>25%) is the main determinant of renal survival. We hypothesize that in patients with systemic AL amyloidosis and type 5 cardiorenal syndrome both OS and renal survival is primarily dictated by cardiac organ response as defined by current consensus criteria.

Methods

1000 patients were prospectively enrolled into the UK ALCHEMY study from 2009-2016; 318 patients were diagnosed with cardiorenal syndrome. We report OS, renal survival and time to the composite endpoint of death and dialysis. Organ outcomes were defined according to consensus criteria, NTproBNP increase/decrease of >30% (cardiac progression/regression) and reduction in eGFR >25% (renal progression).

Results

Median age was 66yr, eGFR 55ml/min and NTproBNP 655ng/L. Median systolic BP was 112mmHg. 199 patients died and 50 required RRT with an overall survival of 18.5 months by Kaplan Meier analysis. Factors predictive at baseline of OS, renal survival and composite endpoint were NTproBNP (p<0.001, p<0.008, 0<0.001), systolic BP (p<0.001, p<0.03, p<0.007) and eGFR (p<0.001, p<0.001, p<0.001).
Cardiac progression (NTproBNP increase >30%) compared to renal progression (eGFR reduction of >25%) at 12 months was more predictive of death (HR 5.0 vs 1.3, p<0.001), dialysis (HR 3.7 vs 2.7, p=0.017) and composite endpoint (HR 3.8 vs 1.7, p<0.001).
Cardiac response (NT-proBNP reduction of >30%) compared to renal response (reduction in proteinuria by 30% without >25% reduction in eGFR) at 12 months was also more predictive of OS (HR 0.3 vs 0.8, p<0.001), renal survival (HR 0.3 vs 0.6, p=0.008) and composite endpoint (HR 0.3 vs 1.0, p<0.001).

Conclusion

OS, renal survival and the composite endpoint of death or dialysis in patients with type 5 cardiorenal syndrome in systemic AL amyloidosis are strongly associated with baseline eGFR, systolic BP and NTproBNP. Cardiac organ response at 12 months, as defined by consensus criteria, is more predictive of both patient and renal survival in this cohort of patients than renal organ response.