Abstract: SA-PO1172
Early Progressive CKD in Wild-Type Transthyretin Cardiac Amyloidosis: Prediagnostic Trajectory and Mortality Risk
Session Information
- CKD: SGLT2 Inhibitors and GLP-1 RAs for Kidney Health
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Allam, Krishna C, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Nasr, Kristina Karim, Cleveland Clinic, Cleveland, Ohio, United States
- Evans, Michael David, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Maharaj, Valmiki R., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Karam, Sabine, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
Background
Chronic kidney disease (CKD) is frequent in patients with wild-type transthyretin cardiac amyloidosis (wtATTR-CA). Although CKD predicts poor outcomes in wtATTR-CA, the trajectory of CKD severity before diagnosis and its independent mortality impact remain unclear, especially when accounting for comorbidities (diabetes [DM], hypertension [HTN], heart failure [HF]). This study assessed CKD prevalence in the years preceding wtATTR-CA diagnosis and evaluated its independent effect on mortality.
Methods
We retrospectively analyzed 92 wtATTR-CA patients (2011–2024; median age 79.7 years; 93.5% male), excluding those with AL amyloidosis. Clinical CKD status and comorbidities (DM, HTN, HF) were assessed at 5 years (-5y), 3 years (-3y), and 1 year (-1y) prior to, and at the time of diagnosis (Dx). Mortality risk was evaluated using Kaplan-Meier survival curves and Cox regression models, adjusted for age and comorbidities.
Results
CKD prevalence increased from 16.3% at -5y to 30.4% at -1y, reaching 43.5% at Dx. CKD (≥ stage 3B) rose from 5.4% at -5y to 6.5% at -1y and 14.1% at Dx. HTN remained consistently prevalent, while HF incidence progressively increased, reaching 77.2% at Dx. After adjustment for age and comorbidities, CKD (≥ stage 3B) significantly predicted higher mortality at -3y (HR 8.41, p=0.001) and -1y (HR 11.08, p=0.002). Stage 2–3A CKD was also associated with increased mortality risk, reaching significance at -1y (HR 3.41, p=0.007).
Conclusion
CKD prevalence and severity progressively increase in the years leading up to wtATTR-CA Dx. CKD ( ≥ stage 3B) independently and markedly elevates mortality risk as early as -3y, even after adjusting for comorbidities. Nephrologists should consider wtATTR-CA in elderly patients with unexplained or progressive CKD, particularly if accompanied by HF or systemic features such as carpal tunnel syndrome. Recognizing CKD as an early prognostic marker may support timely diagnosis and improve risk stratification.