Abstract 14284: Temporal Evolution of Renal Markers for Personalized Risk Assessment in Chronic Heart Failure
Introduction: Single ‘baseline’ assessments of glomerular filtration and tubular damage independently predict clinical outcome in patients with chronic heart failure (CHF). However, the temporal relationship is not known. We investigated whether temporal patterns of renal markers predict adverse clinical outcome in patients with CHF.
Methods: In 263 CHF patients, we repeatedly assessed markers of glomerular function: cystatin C (CysC), creatinine, estimated glomerular filtration rate (eGFR); and tubular damage markers: urinary N-acetyl-beta-d-glucosaminidase (NAG) and kidney injury molecule (KIM)-1, plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL). We investigated the associations between temporal patterns of renal markers and the composite endpoint of HF hospitalizations, cardiovascular death, LVAD placement and heart transplantation. We used time to first event and applied joint modeling, which combines mixed models for subject-specific marker evolution and Cox regression for occurrence of the composite endpoint.
Results: Mean age was 67 years, 82% were men and 26% were in NYHA class III/IV. During a median (IQR) follow up of 2.2 (1.4-2.5) years, we collected 1912 urine and 1984 plasma samples (per patient: 8 (5-10) urine and 9 (5-10) plasma). Seventy endpoints occurred. We found different temporal evolutions in patients who reached the endpoint and those who did not (Figure). Repeatedly assessed glomerular function markers were independently associated with outcome: per 20% creatinine increase: adjusted HR [95% CI]: 1.16 [1.03-1.31]; per 10 mL/min/1.73m2 eGFR decrease: 1.46 [1.12-1.92]; per 20% CysC increase: 2.75 [1.91-3.98]. The tubular markers urinary NAG and KIM-1 were independently associated with outcome: per doubling of KIM-1: adjusted HR [95% CI]: 1.71 [1.16-2.12]; per doubling of NAG: 2.14 [1.30-3.34].
Conclusion: Individual, temporal patterns of renal markers predict clinical outcome in patients with CHF.
Author Disclosures: M. Brankovic: None. K. Akkerhuis: None. A. Constantinescu: None. K. Caliskan: None. O. Manintveld: None. J. Cornel: None. S. Baart: None. D. Rizopoulos: None. H. Hillege: None. E. Boersma: None. V. Umans: None. I. Kardys: None.
- © 2016 by American Heart Association, Inc.