Abstract: TH-PO490

Estimated GFR Variability: A Novel Predictor of Cardiac Outcome in Outpatients with Congestive Heart Failure

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

  • Oka, Tatsufumi, Osaka University Graduate School of Medicine, Suita, Japan
  • Hamano, Takayuki, Osaka University Graduate School of Medicine, Suita, Japan
  • Yamaguchi, Satoshi, Osaka University Graduate School of Medicine, Suita, Japan
  • Kubota, Keiichi, Osaka University Graduate School of Medicine, Suita, Japan
  • Senda, Masamitsu, Osaka University Graduate School of Medicine, Suita, Japan
  • Yonemoto, Sayoko, Osaka University Graduate School of Medicine, Suita, Japan
  • Sakaguchi, Yusuke, Osaka University Graduate School of Medicine, Suita, Japan
  • Matsui, Isao, Osaka University Graduate School of Medicine, Suita, Japan
  • Isaka, Yoshitaka, Osaka University Graduate School of Medicine, Suita, Japan
Background

Reportedly, variability in renal function is associated with mortality and CKD progression in predialysis patients with CKD. However, its clinical relevance in patients with congestive heart failure (CHF) is uncertain.

Methods

In this retrospective cohort study, we enrolled CHF patients who were discharged from an educational hospital. Using 6-month data just after discharge, we linearly regressed each patient’s eGFR on time and calculated eGFR variability (EGV) as “mean sqrt(residuals of eGFR)2 / mean eGFR ×100(%)”. Exposure of this study was EGV, and outcome was death or hospitalization rates over the follow-up period starting 6 months after discharge. For main analyses, we employed negative binomial regression models. As sensitivity analyses, we used Cox proportional hazards models to estimate the hazard risk of mortality or readmission whichever occurred first. Additionally, we calculated the net reclassification index (NRI) and the integrated discrimination index (IDI) of EGV.

Results

Among the 351 outpatients, median left ventricular ejection fraction, eGFR, EGV, and follow-up period were 54%, 57.5 mL/min/1.73m2, 4.4%, and 23.6 months, respectively. Multivariate negative binomial regression analyses showed that higher EGV was associated with an increased incidence rate ratio for the outcome (Figure 1). Excluding the patients with their eGFR measured only 3 times during 6 months after discharge didn’t change the results substantially. Cox regression analyses also showed that EGV of Q3 had significantly higher hazard ratio (HR) than the combined group of Q1 and Q2 (HR, 2.00; 95%CI, 1.27 to 3.15) (Figure 2). The NRI and IDI were 0.283 (P=0.014) and 0.013 (P=0.038), respectively.

Conclusion

Higher eGFR variability predicts worse cardiac outcome in outpatients with CHF.