Kidney function trajectories before and after hospitalization for heart failure with reduced ejection fraction

作者：Masatake Kobayashi, Antoni Bayés‐Genís, Kévin Duarte, John J.V. McMurray, João Pedro Ferreira, Stuart Pocock, Dirk Jan van Veldhuisen, Josep Lupón, Bertram Pitt, Faiez Zannad, Nicolas Girerd · 发表于：European Heart Journal · 年份：2025 · DOI：10.1093/eurheartj/ehaf457 · 被引用次数：16 · 研究领域：Heart Failure Treatment and Management、Cardiovascular Function and Risk Factors、Chronic Kidney Disease and Diabetes

BACKGROUND AND AIMS: Worsening kidney function is a key prognostic factor in heart failure (HF) with reduced ejection fraction (HFrEF). However, associations between kidney function trajectories and HF-related events remain unclear. METHODS: Longitudinal changes in estimated glomerular filtration rate (eGFR) before and after a HF-related event, defined as HF hospitalization or HF death, were examined using individual patient data from two clinical trials (EPHESUS and EMPHASIS-HF) and a real-world cohort (BARCELONA). RESULTS: HF-related events occurred in 14.1% of 8587 patients [EPHESUS/EMPHASIS-HF; median follow-up 17.1 (12.4-22.7) months] and 33.8% of 2048 patients [BARCELONA; median 47.0 (18.8-90.6) months]. In EPHESUS and EMPHASIS-HF, patients who experienced an HF-related event had a steeper decline in eGFR in the year preceding the event (average -4.83 mL/min/1.73 m²/year) compared with those who did not have an HF-related event (-1.18 mL/min/1.73 m²/year). Over the 1 year following an HF-related event, eGFR continued to decline, though at a slower rate (average -3.45 mL/min/1.73 m²/year). Similar kidney function trajectories were observed in BARCELONA (average eGFR decline -1.35 mL/min/1.73 m²/year in patients without HF event vs -5.77 mL/min/1.73 m²/year 1 year before an event and -3.04 mL/min/1.73 m²/year over the year after an event). Worsening New York Heart Association class paralleled steeper eGFR decline prior to HF events. CONCLUSIONS: In HFrEF, kidney function ...