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Kidney Week

Abstract: PO2247

Association Between Rates of In-Hospital Decongestion Among Patients with Heart Failure with Reduced Ejection Fraction with Longer-Term Kidney Outcomes

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): 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
  • Testani, Jeffrey M., Yale University School of Medicine, New Haven, Connecticut, United States
  • Griffin, Matthew, Yale University School of Medicine, New Haven, Connecticut, 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

Achievement of decongestion in acute heart failure (AHF) is associated with improved cardiovascular outcomes, but can be associated with acute declines in estimated glomerular filtration rate (eGFR). We aimed to examine whether rate of in-hospital decongestion is associated with longer term kidney function decline among patients with heart failure with reduced ejection fraction (HFrEF).

Methods

Using data from the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial, we used multivariable Cox regression models to evaluate the association between in-hospital change in assessments of volume overload, including b-type natriuretic peptide (BNP), N-terminal prob-type natriuretic peptide (NT-proBNP) and clinical congestion score (0-12), as well as change in hemoconcentration including hematocrit, albumin and total protein with risk of incident chronic kidney disease (CKD) Stage≥4 (as defined by a new eGFR <30 ml/min/1.73m2) and eGFR decline of >40%.

Results

Among 3500 patients over 10-month follow-up, faster decreases in volume overload and more rapid increases in hemoconcentration were associated with decreased risk of incident CKD Stage≥4 and eGFR decline of >40%. In adjusted analyses, for every 6% faster decline in BNP per week, there was a 32% lower risk of both incident CKD Stage≥4 (HR=0.68, 95% CI 0.58, 0.79) and eGFR decline by >40% (HR=0.68 [0.57, 0.80]). For every 1% faster increase per week in hematocrit, there was a lower risk for both incident CKD Stage≥4 (HR=0.73 [0.64, 0.84]) and eGFR decline by >40% (HR=0.82 [0.71, 0.95]), with results consistent for other biomarkers.

Conclusion

These results provide reassurance that more rapid rates of decongestion in patients with AHF do not increase the risk of adverse kidney outcomes in patients with HFrEF, and may in fact be associated with better kidney function in the long term. The ability to rapidly decongest may also serve as a valuable proxy for better kidney outcomes.