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Kidney Week

Abstract: SA-PO709

Comparison Between Longitudinal Kidney Function and Volume Changes in Association with Heart Failure Outcomes Among Discharged Patients in EVEREST

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Oka, Tatsufumi, Tufts Medical Center, Boston, Massachusetts, United States
  • Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
  • McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States
  • Tuttle, Marcelle, 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

Decongestion can result in kidney function decline. The relative clinical importance of changes in kidney function and changes in volume status remains uncertain in outpatient HF settings.

Methods

This post-hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial analyzed patients who survived HF hospitalization. As time-varying exposures, worsened kidney function (WKF) and worsened congestion (WCG) were defined as any decrease in eGFR and any increase in B-type natriuretic peptide (BNP) in comparison with values at discharge, respectively. We examined the association of 4 groups (non-WKF, non-WCG group; WKF, non-WCG group; non-WKF, WCG group; and WKF, WCG group) with the composite of cardiovascular death or HF re-hospitalization, particularly focusing on the comparison between WKF, non-WCG and non-WKF, WCG groups. Marginal structural models, which can create a balanced pseudo-population throughout follow-up, were applied to account for time-dependent confounding.

Results

Among 3666 patients, median age, eGFR, and BNP at discharge were 67 years, 57.9 mL/min/1.73 m2, and 441.9 pg/mL, respectively. During follow-up (median, 44 weeks), 631 patients died due to cardiovascular disease and 1160 experienced HF re-hospitalization. After adjustment for time-dependent confounders, a significant trend was observed in the association between the 4 groups and study outcome with the highest risk in WKF, WCG group (Figure A). Patients in WKF, non-WCG group had a 33%-lower risk of the composite outcome than those in non-WKF, WCG group (Figure B).

Conclusion

WKF-WCG categories discriminated the risk of HF outcomes in discharged patients with HF. Patients in WKF, non-WCG group had fewer adverse HF outcomes than those in non-WKF, WCG group, suggesting the importance of sustaining decongestion over preserving kidney function.