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Kidney Week

Abstract: TH-PO065

Relation Between Biomarkers of Decongestion and Kidney Function with Outcomes in Acute Decompensated Heart Failure

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States
  • Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
  • Konstam, Marvin, Tufts Medical Center, Boston, Massachusetts, United States
  • Udelson, James, Tufts Medical Center, Boston, Massachusetts, United States
  • Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States
Background

In-hospital acute declines in kidney function occur in approximately 20-30% of patients admitted with acute decompensated heart failure (ADHF), but it remains unknown whether these declines are associated with improved or worse outcomes, and whether incorporation of markers of congestion modifies these associations.

Methods

Using data from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial, multivariable Cox regression models were used to evaluate the association between in-hospital changes in eGFR and changes in brain natriuretic peptide (BNP) with death and a composite outcome of death or rehospitalization. The association of eGFR decline with outcomes within subgroups of changes in other surrogate markers of congestion including N-terminal prohormone of brain natriuretic peptide, hematocrit, and weight was also examined.

Results

Among 3,988 patients over a median 8-month follow-up, in-hospital decline in eGFR was not significantly associated with outcomes (HR=1.09 [95% CI 0.96, 1.24] for death per every 30% decline in eGFR; 1.03 [95% CI 0.95, 1.12] for composite per every 30% decline in eGFR), whereas there was a 24% reduction in risk of death for every halving of BNP (HR=0.76 [95% CI 0.71, 0.83]). There was no significant interaction between decline in eGFR and change in BNP for either death (p-interaction =0.09) or the composite of death or rehospitalization (p-interaction =0.35) (Figure). Decline in eGFR was not found to be significantly associated with either improved or worse outcomes in any subgroups of either increasing or decreasing markers of congestion (p-interaction 〉0.12 for all subgroups).

Conclusion

Achieving decongestion is an important goal for patients with ADHF and declines in BNP are associated with better prognosis. The prognostic significance of declines in eGFR, however, remains less clear, even if occurring in the setting of achieving decongestion.

Funding

  • Other NIH Support