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 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: (i) time to ≥50% decline in estimated glomerular filtration rate (eGFR); (ii) development of end-stage renal disease; or (iii) death attributable to renal causes. A total of 2306 (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 versus valsartan was similar between patients with (hazard ratio [HR] 0.43; 95% confidence interval [CI] 0.24–0.76) and without (HR 0.63; 95% CI: 0.33–1.18; 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: Heart failure hospitalization denotes increased risk for kidney disease progression which continues following recovery from HF decompensation in patients with HF with preserved ejection fraction. Clinical Trial Registration: PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction), ClinicalTrials.gov NCT01920711.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | European Journal of Heart Failure |
| Vol/bind | 24 |
| Udgave nummer | 10 |
| Sider (fra-til) | 1906-1914 |
| ISSN | 1388-9842 |
| DOI | |
| Status | Udgivet - 2022 |
Bibliografisk note
Funding Information:PARAGON‐HF was funded by Novartis Pharmaceuticals.
Funding Information:
S.C. is supported by the Canadian Arthur J.E. Child's Scholarship, Libin Cardiovascular Institute of Alberta. M.V. has received research grants from and/or serves on advisory boards for American Regent, Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, Boehringer Ingelheim, Cytokinetics, Relypsa, Roche Diagnostics, Sanofi, and Tricog Health, has participated in speaking engagements supported by AstraZeneca, Roche Diagnostics, and Novartis, and participates in clinical trial committees for studies sponsored by AstraZeneca, Occlutech, Impulse Dynamics, Galmed, Bayer AG, and Novartis. A.P. receives a research grant from the German Research Foundation. B.L.C. has been a consultant for Amgen, AO Biome, Biogen, Boehringer Ingelheim, Corvia, Gilead, Myokardia, Cardurion, and Novartis. F.R.M. is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases grants and Satellite Healthcare, and reports research funding paid directly to his institution from Advanced Medical and Fifth Eye. M.A.P. has received grants paid to his institution for serving on the Steering Committee of PARAGON‐HF, and for serving as Study Chair of Prospective ARNI vs ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI (PARADISE‐MI) from Novartis and personal fees for consulting from AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance, Corvidia, DalCor, GlaxoSmithKline, Lexicon, NHLBI CONNECTs (Master Protocol Committee), Novartis, Novo Nordisk, Peerbridge, and Sanofi; and has equity in DalCor. L.K. has received payments to his institution from AstraZeneca and Novartis for participation in trial executive committees; he also received lecture fees from Novartis. P.S. reports honoraria for lectures from Medtronic, Abbott, Servier, AstraZeneca, Respicardia; consultancy agreement and honoraria for lecturer from Boehringer Ingelheim, Novartis; and consultancy agreement from Vifor Pharma. M.L. is an employee of Novartis. J.J.V.M. has received grants and his employer paid by AstraZeneca, Theracos, and GlaxoSmithKline during the conduct of the study and grants and his employer being paid by Novartis, Amgen, Bristol Myers Squibb, Bayer, Abb‐vie, Dal‐Cor, Kidney Research UK, and Cardurion and grants from British Heart Foundation. S.D.S. has received research grants from Actelion, Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, BMS, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lilly, Mesoblast, MyoKardia, NIH/NHLBI, Neurotronik, Novartis, NovoNordisk, Respicardia, Sanofi Pasteur, Theracos, US2.AI, and has consulted for Abbott, Action, Akros, Alnylam, Amgen, Arena, AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Cardior, Cardurion, Corvia, Cytokinetics, Daiichi‐Sankyo, GSK, Lilly, Merck, Myokardia, Novartis, Roche, Theracos, Quantum Genomics, Cardurion, Janssen, Cardiac Dimensions, Tenaya, Sanofi‐Pasteur, Dinaqor, Tremeau, CellProThera, Moderna, American Regent, Sarepta, Lexicon, Anacardio, Akros, Puretech Health. All other authors have nothing to disclose. Conflict of interest:
Publisher Copyright:
© 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.