Kidney function trajectories before and after hospitalization for heart failure with reduced ejection fraction
Kobayashi, Masatake (Université de Lorraine)
Bayés-Genís, Antoni (Universitat Autònoma de Barcelona. Departament de Medicina)
Duarte, Kevin (Université de Lorraine)
McMurray, John J V (University of Glasgow)
Ferreira, João Pedro (Université de Lorraine)
Pocock, Stuart J (London School of Hygiene and Tropical Medicine)
Van Veldhuisen, Dirk J (University of Groningen)
Lupón, Josep (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Pitt, Bertram (University of Michigan School of Medicine)
Zannad, Faiez (Université de Lorraine)
Girerd, Nicolas (Université de Lorraine)

Fecha:	2025
Resumen:	Worsening kidney function is a key prognostic factor in heart failure (HF) with reduced ejection fraction (HFrEF). However, associations between kidney function trajectories and HF-related events remain unclear. Longitudinal changes in estimated glomerular filtration rate (eGFR) before and after a HF-related event, defined as HF hospitalization or HF death, were examined using individual patient data from two clinical trials (EPHESUS and EMPHASIS-HF) and a real-world cohort (BARCELONA). HF-related events occurred in 14. 1% of 8587 patients [EPHESUS/EMPHASIS-HF; median follow-up 17. 1 (12. 4-22. 7) months] and 33. 8% of 2048 patients [BARCELONA; median 47. 0 (18. 8-90. 6) months]. In EPHESUS and EMPHASIS-HF, patients who experienced an HF-related event had a steeper decline in eGFR in the year preceding the event (average -4. 83 mL/min/1. 73 m²/year) compared with those who did not have an HF-related event (-1. 18 mL/min/1. 73 m²/year). Over the 1 year following an HF-related event, eGFR continued to decline, though at a slower rate (average -3. 45 mL/min/1. 73 m²/year). Similar kidney function trajectories were observed in BARCELONA (average eGFR decline -1. 35 mL/min/1. 73 m²/year in patients without HF event vs -5. 77 mL/min/1. 73 m²/year 1 year before an event and -3. 04 mL/min/1. 73 m²/year over the year after an event). Worsening New York Heart Association class paralleled steeper eGFR decline prior to HF events. In HFrEF, kidney function decline may precede a HF hospitalization or death by up to 1 year, linking to symptomatic congestion. Monitoring eGFR slopes rather than relying solely on specific cut-off values may allow early detection of at-risk patients.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Heart failure with reduced ejection fraction ; Kidney function ; Cardiorenal syndrome ; Mineralocorticoid receptor antagonist ; Heart failure hospitalization
Publicado en:	European heart journal, Vol. 46, Num. 43 (July 2025) , p. 4583-4593, ISSN 1522-9645

DOI: 10.1093/eurheartj/ehaf457
PMID: 40737218

11 p, 1.3 MB

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