Patient-specific evolution of renal function in chronic heart failure patients dynamically predicts clinical outcome in the Bio-SHiFT study.
Kidney Int
; 93(4): 952-960, 2018 04.
Article
em En
| MEDLINE
| ID: mdl-29191357
ABSTRACT
Renal dysfunction is an important component of chronic heart failure (CHF), but its single assessment does not sufficiently reflect clinically silent progression of CHF prior to adverse clinical outcome. Therefore, we aimed to investigate temporal evolutions of glomerular and tubular markers in 263 stable patients with CHF, and to determine if their patient-specific evolutions during this clinically silent period can dynamically predict clinical outcome. We determined the risk of clinical outcome (composite endpoint of Heart Failure hospitalization, cardiac death, Left Ventricular Assist Device placement, and heart transplantation) in relation to marker levels, slopes and areas under their trajectories. In each patient, the trajectories were estimated using repeatedly measured glomerular markers creatinine/estimated glomerular filtration rate (eGFR), cystatin C (CysC), and tubular markers urinary N-acetyl-beta-D-glucosaminidase (NAG) and kidney injury molecule (KIM)-1, plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL). During 2.2 years of follow-up, we collected on average 8 urine and 9 plasma samples per patient. All glomerular markers predicted the endpoint (univariable hazard ratio [95% confidence interval] per 20% increase creatinine 1.18[1.07-1.31], CysC 2.41[1.81-3.41], and per 20% eGFR decrease 1.13[1.05-1.23]). Tubular markers, NAG, and KIM-1 also predicted the endpoint (NAG 1.06[1.01-1.11] and KIM-1 1.08[1.04-1.11]). Larger slopes were the strongest predictors (creatinine 1.57[1.39-1.84], CysC 1.76[1.52-2.09], eGFR 1.59[1.37-1.90], NAG 1.26[1.11-1.44], and KIM-1 1.64[1.38-2.05]). Associations persisted after multivariable adjustment for clinical characteristics. Thus, during clinically silent progression of CHF, glomerular and tubular functions deteriorate, but not simultaneously. Hence, patient-specific evolutions of these renal markers dynamically predict clinical outcome in patients with CHF.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Temas:
Geral
Base de dados:
MEDLINE
Assunto principal:
Volume Sistólico
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Função Ventricular Esquerda
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Taxa de Filtração Glomerular
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Insuficiência Cardíaca
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Rim
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Nefropatias
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Kidney Int
Ano de publicação:
2018
Tipo de documento:
Article