Association of Estimated GFR Slope and Heart Failure Progression in Older Adults.

Abstract

Rationale & objective: The impact of the estimated glomerular filtration rate (eGFR) slope on the progression of heart failure (HF) remains unclear. This study investigated the association of eGFR slope and the occurrence of incident HF in older adults either at elevated risk for HF or with cardiac abnormalities (structural, hemodynamic, or biomarker) (pre-HF).

Study design: Prospective cohort study.

Setting & participants: 5,362 participants in the Atherosclerosis Risk in Communities at study visit 5 free of HF (at elevated risk [stage A]: n=1,262, with cardiac abnormalities [stage B]: n=4,100).

Exposure: EGFR slope (estimated from eGFR measurements between visits 1 and 5 using linear mixed-effects models) OUTCOME: Incident clinical heart failure based on hospitalization ICD-9/10 codes ANALYTICAL APPROACH: Cause-Specific hazards models.

Results: The mean age was 75.7 years, 58.4% were female, and the median follow-up was over 6 years. No significant association was found among individuals in Stage A. In Stage B, each 1 mL/min/1.73 m2 per year decrease in eGFR slope was associated with a higher risk of HF (HR, 1.39, 95% CI: 1.11-1.73). Multivariable-adjusted cubic spline analysis indicated that this association was nonlinear among individuals in Stage B (p non-linearity=0.02). Compared to individuals with a moderate-to-high decline in eGFR (-1.87 to -1.25 mL/min/1.73 m2 per year), individuals in Stage B with a steeper eGFR slope (<-1.87 mL/min/1.73 m2 per year) exhibited an increased risk of incident HF (HR, 1.58, 95% CI: 1.20-2.10). A steeper eGFR slope in Stage B was also significantly associated with HF with preserved ejection fraction (HFpEF) (HR, 1.54, 95% CI: 1.10-2.17). Among individuals in Stage B, there was no detectably elevated risk of incident clinical HF when eGFR slope was greater than -1.25 mL/min/1.73 m² per year.

Limitations: The eGFR slope may not fully capture the complexity of kidney function decline, as it may not account for the fluctuating patterns.

Conclusions: The eGFR slope may be a valuable measurement to identify individuals at high risk of developing HF, particularly HFpEF.