Patient-specific evolution of renal function in chronic heart failure patients dynamically predicts clinical outcome in the Bio-SHiFT study

Autor: Dimitris Rizopoulos, Sharda S. Anroedh, Olivier C. Manintveld, Isabella Kardys, Kadir Caliskan, Victor A. Umans, Hans L. Hillege, Jan H. Cornel, Alina A. Constantinescu, Milos Brankovic, Nick van Boven, K. Martijn Akkerhuis, Eric Boersma, Sara J. Baart
Přispěvatelé: Life Course Epidemiology (LCE), Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Cardiology, Epidemiology
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
CHRONIC KIDNEY-DISEASE
Time Factors
medicine.medical_treatment
temporal evolution
heart failure
030204 cardiovascular system & hematology
Kidney
COLLABORATION
GUIDELINES
Ventricular Function
Left
chemistry.chemical_compound
0302 clinical medicine
Risk Factors
Cause of Death
030212 general & internal medicine
Prospective Studies
Netherlands
Heart transplantation
Aged
80 and over
Ejection fraction
biology
Hazard ratio
dynamic prediction
Middle Aged
EUROPEAN-SOCIETY
Hospitalization
Treatment Outcome
Nephrology
Cardiology
Disease Progression
individual risk
Female
Kidney Diseases
Glomerular Filtration Rate
tubular markers
medicine.medical_specialty
Urinary system
BIOMARKERS
Renal function
DIAGNOSIS
EJECTION FRACTION
03 medical and health sciences
Predictive Value of Tests
Internal medicine
renal dysfunction
medicine
INJURY
Humans
Aged
Creatinine
TUBULAR DAMAGE
business.industry
Stroke Volume
medicine.disease
DYSFUNCTION
Endocrinology
Cystatin C
chemistry
Heart failure
biology.protein
Heart Transplantation
Heart-Assist Devices
business
Zdroj: Kidney International, 93(4), 952-960. ELSEVIER SCIENCE INC
Kidney International, 93(4), 952-960. Elsevier Inc.
ISSN: 0085-2538
Popis: 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.
Databáze: OpenAIRE
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