Kidney Week

Abstract: TH-PO200

Association of Pulmonary Arterial Pulsatility Index (PAPi) with Kidney Outcomes Among Patients Admitted for Acute Decompensated Heart Failure

Session Information

• Hypertension and CVD: Clinical - I
  November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Tuttle, Marcelle, Tufts Medical Center, Boston, Massachusetts, United States

Marcelle Tuttle,

• Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States

Hocine Tighiouart,

• Testani, Jeffrey M., Yale University, New Haven, Connecticut, United States

Jeffrey M. Testani,

• Banlengchit, Run, Tufts Medical Center, Boston, Massachusetts, United States

Run Banlengchit,

• Moises, Amanda I., Tufts Medical Center, Boston, Massachusetts, United States

Amanda I. Moises,

• Sarnak, Hannah Leigh, Tufts Medical Center, Boston, Massachusetts, United States

Hannah Leigh Sarnak,

• Oka, Tatsufumi, Tufts Medical Center, Boston, Massachusetts, United States

Tatsufumi Oka,

• Kiernan, Michael S., Tufts Medical Center, Boston, Massachusetts, United States

Michael S. Kiernan,

• Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States

Mark J. Sarnak,

• McCallum, Wendy I., Tufts Medical Center, Boston, Massachusetts, United States

Wendy I. McCallum,

Background

Pulmonary arterial pulsatility index (PAPi), defined as (pulmonary artery (PA) systolic pressure - PA diastolic pressure)/right atrial pressure, has emerged as a novel marker to capture right ventricular failure. Lower PAPi is associated with increased risk of death but has not been studied in association with renal outcomes.

Methods

Records for patients requiring a PA catheter for acute decompensated heart failure (ADHF) admissions to a single quaternary center between 2015-2021 were reviewed. PAPi was calculated based on the initial measurements; values were log-transformed given their skewed distribution. Linear regression models were used to examine the cross-sectional association of PAPi with baseline estimated glomerular filtration rate (eGFR) and in-hospital eGFR slope. Patient records were linked to the US Renal Data System to capture dialysis outcomes. We used multivariable Cox proportional hazards regression models to examine the association of PAPi with dialysis and the composite endpoint of death or heart transplant (HT). Covariates included demographics, measures of cardiac disease severity and medications.

Results

Among 753 patients with mean age 62 (SD 14) years, median PAPi was 2.0 (IQR 1.4, 3.2), mean eGFR of 58 (SD 27) ml/min/1.73m² and mean eGFR slope was 1.2 (SD 6.2) ml/min/1.73m²/week. For every doubling of PAPi, there was a 3.3 ml/min/1.73m² (95% CI 1.5, 5.2) higher baseline eGFR, and 0.7 (95% CI 0.3, 1.2) ml/min/1.73m²/week higher in-hospital eGFR slope. Over median follow-up of 23 (IQR 8, 47) months, 62 (8%) reached dialysis and 365 (48%) reached the composite endpoint. Higher PAPi was associated with significantly lower risk of requiring dialysis both in unadjusted and adjusted models (Table). Higher PAPi also trended toward decreased risk for the composite outcome (Table).

Conclusion

Higher PAPi is associated with higher baseline eGFR, higher in-hospital eGFR slope and lower risk of progression to dialysis in patients admitted for ADHF.

Funding

• NIDDK Support