Abstract: SA-PO0421
Kidney Markers Predict Mortality in Wild-Type Transthyretin Cardiac Amyloidosis: Implications for Earlier Screening
Session Information
- CKM: Clinical - Epidemiology and Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Allam, Krishna C., University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Bommidi, Aarya S., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Nasr, Kristina Karim, Cleveland Clinic, Cleveland, Ohio, United States
- Karam, Sabine, University of Minnesota Medical School, Minneapolis, Minnesota, United States
Background
Amyloidosis is a group of disorders characterized by the formation of insoluble amyloid fibrils that disrupt the architecture and function of organs. Transthyretin amyloidosis has genetic (hATTR) and wild type (ATTRwt) variants. Although primarily affecting the heart (ATTR-CA), ATTR also causes systemic complications that affect the kidney. While the impact of hATTR on kidney health has been well described, ATTRwt’s impact and course remain unclear. This retrospective study investigated markers of kidney health –glomerular filtration rate (eGFR), sodium (Na+), potassium (K+), and bicarbonate (CO2)– up to five years before and at ATTRwt-CA diagnosis to evaluate their association with mortality.
Methods
This retrospective cohort study included 190 patients with ATTRwt-CA diagnosed 2011-2024 (median age 80 [IQR 75-85]; 93% male; 90% White). eGFR, Na+, K+, and CO2 were assessed at 5,3, and 1 year prior to and at diagnosis. Linear mixed models characterized longitudinal trends; multivariate Cox proportional hazards models adjusted for age and all metabolic variables simultaneously assessed associations with all-cause mortality.
Results
Among 135 patients with complete data, lower eGFR predicted higher mortality at 3 years prior (HR 0.976/mL/min/1.73m2, p = 0.01), 1 year prior (HR 0.967, p<0.001), and at diagnosis (HR 0.969, p <0.001); eGFR decline rate did not. Lower K+ and higher CO2 each predicted worse survival at 1 year prior (K+ HR 0.179, p = 0.001; CO2 HR 1.153, p = 0.04) and at diagnosis (K+ HR 0.181, p = 0.002; CO2 HR 1.138, p = 0.04). Na+ was not significant at any timepoint.
Conclusion
Several kidney health markers are associated with increased mortality prior to and at time of ATTRwt-CA diagnosis, serving as potential red flags to prompt for earlier screening and management in elderly male patients.