Highlights
- •Variability in the estimated glomerular filtration rate was higher in those with heart failure and chronic kidney disease relative to those with only chronic kidney disease.
- •Patients with heart failure with reduced ejection fraction displayed the greatest amount of variability in the estimated glomerular filtration rate.
- •Variability in the estimated glomerular filtration rate was associated with a greater risk of death in all participants.
- •The risk of death was independent of heart failure phenotype.
Abstract
Background
Greater variability in the estimated glomerular filtration rate (eGFR) is associated
with higher mortality in patients with chronic kidney disease (CKD). Heart failure
(HF) is common in CKD and may increase variability through changes in hemodynamic
and volume regulation. We sought to determine if patients with vs without HF have
higher kidney function variability in CKD, and to define the association with mortality.
Methods and Results
Patients undergoing coronary angiography from 2003 to 2013 with an eGFR of less than
60 mL/min/1.73 m2 were evaluated from the Duke Databank for Cardiovascular Disease. Variability in
the eGFR, measured as the coefficient of variation (CV) of residuals from the regression
of eGFR vs time, was calculated spanning 3 months to 2 years after catheterization.
Mortality was assessed 2 to 7 years after catheterization. Patients were grouped into
3 HF phenotypes: HF with reduced ejection fraction, HF with preserved ejection, and
no HF. Regression was used to evaluate associations between HF phenotypes and variability
in the eGFR and between variability in the eGFR and mortality rate with stratification
by HF phenotype. Among 3767 participants, the median eGFR at baseline was 45 mL/min/1.73
m2 (interquartile range 33-53 mL/min/1.73 m2), and longitudinal measures of eGFR over 21 months had within-patient residual variability
(CV) of 14% (9%–20%). In adjusted analyses, variability in the eGFR was greater in
those with HF with preserved ejection (n = 695, CV difference 0.98%, 95% confidence interval 0.14%–1.81%) or HF with reduced
ejection fraction (n = 800, CV difference 2.51%, 95% confidence interval 1.66%–3.37%) relative to no HF
(n = 2272). In 3068 participants eligible for mortality analysis, the presence of HF
and greater variability in the eGFR were each associated independently with higher
mortality, but there was no evidence of interaction between variability in the eGFR
and any HF phenotype (all P for interaction ≥.49).
Conclusions
Variability in the eGFR is greater in patients with HF and associated with mortality.
Prediction algorithms and classification schemes should consider not only static,
but also dynamic eGFR variability in HF and CKD prognostication.
Graphical Abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: May 07, 2021
Accepted:
April 11,
2021
Received in revised form:
April 9,
2021
Received:
February 18,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
