Longitudinal trajectories in renal function before and after heart failure hospitalization among patients with HFpEF in the PARAGON‐HF trial

Chatur, S. et al. (2022) Longitudinal trajectories in renal function before and after heart failure hospitalization among patients with HFpEF in the PARAGON‐HF trial. European Journal of Heart Failure, 24(10), pp. 1906-1914. (doi: 10.1002/ejhf.2638) (PMID:35895867)

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Abstract

Aims: Worsening renal function may impact long-term outcomes in heart failure (HF). However, little is known about the longitudinal trajectories in renal function in relation to the HF hospitalization or how this high-risk clinical event impacts renal outcomes. Methods and Results: In PARAGON-HF, we evaluated the association between recency of prior HF hospitalization (occurring pre-randomization) and subsequent first renal composite outcome: (1) time to ≥50% decline in eGFR ; (2) development of end stage renal disease (ESRD); or (3) death attributable to renal causes. 2,306 (48.1%) patients had a history of prior HF hospitalization. Incident rates of the renal outcome were highest in those most recently hospitalized and decreased with longer time from last hospitalization. Treatment effect on the renal outcome of sacubitril/valsartan vs. valsartan was similar between patients with (HR 0.43; 95% CI: 0.26 to 0.75) and without (HR 0.63; 95% CI: 0.33 to 1.18; Pinteraction = 0.39) a prior history of HF hospitalization and appeared consistent regardless of timing of prior hospitalization for HF (Pinteraction =0.39). Serial eGFR measurements leading up to and after a HF hospitalization (occurring during the study period) and estimated eGFR trajectories using repeated measures regression models with restricted cubic splines were also examined. Patients experiencing a post-randomization HF hospitalization had a significant decline in eGFR prior to hospitalization while patients without HF hospitalization experienced a relatively stable eGFR trajectory (p<0.001). A change in the rate of decline of eGFR trajectory was observed 12-months preceding a HF hospitalization, and continued in the post-discharge window to 12 months following hospitalization. Conclusions: HF hospitalization denotes increased risk for kidney disease progression which continues following recovery from HF decompensation in patients with HF with preserved ejection fraction.

Item Type:Articles
Additional Information:PARAGON-HF was funded by Novartis Pharmaceuticals.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John and Kober, Professor Lars
Authors: Chatur, S., Vaduganathan, M., Peikert, A., Claggett, B. L., McCausland, F. R., Skali, H., Pfeffer, M. A., Beldhuis, I. E., Kober, L., Seferovic, P., Lefkowitz, M., McMurray, J. J.V., and Solomon, S. D.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:27 July 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in European Journal of Heart Failure 24(10): 1906-1914
Publisher Policy:Reproduced under a Creative Commons License

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