Outcomes Of Patients With Advanced Chronic Kidney Disease And A Pulmonary Artery Pressure Sensor: Insights From The HF2 Registry

Abstract

Introduction

An implantable pulmonary artery pressure (PAP) sensor is approved to reduce heart failure hospitalizations (HFH) in symptomatic patients. Key trials have excluded those with advanced chronic kidney disease (CKD), or eGFR <25 mL/min per 1.73 m². Real-world use of ambulatory hemodynamic monitoring in advanced CKD has not been well-described.

Methods

Hemodynamic Frontiers in Heart Failure (HF²) is an academic consortium of 14 US centers that developed a registry to collect data on patients following implantation with a PAP sensor, including demographics, hemodynamics, and clinical events (ED visits, HFH, or death). We analyzed patients with at least 12 months of hemodynamic monitoring data, comparing events in patients with normal kidney function (eGFR ≥60), mild to moderate CKD (eGFR 30-59), and advanced CKD (eGFR <30). Baseline demographic and implant hemodynamic data were compared using One-Way ANOVA test (IBS SPSS Statistics Version 29.0). In time-to-event analysis, patients who had no events were censored at their 12 month follow up as their last seen date. Those with an event > 12 months from the implant date were censored. The Registry has IRB approval from individual sites and is supported by CTSA Award UL1TR002366.

Results

Of 236 total patients, 70 (29.7%) had advanced and 112 (47.5%) had mild to moderate CKD (Table 1A). Those with CKD were more likely to be older, diabetic, and with higher baseline right atrial and pulmonary artery mean pressures. Patients with CKD had more frequent hospitalizations and those with advanced CKD had more frequent death and progression to LVAD/transplant or ESRD/dialysis (Table 1B). Of those with advanced CKD, only 2 (1.5%) progressed to ESRD.

Conclusion

Longitudinal real-world data from the HF² Registry demonstrates use of PAP sensors in patients with a broad range of kidney function. Although ambulatory hemodynamic monitoring has been shown to reduce HFH, the same may not be true for those with advanced CKD. More research is needed in this high-risk population.