Hospitalization for de novo heart failure or coronary heart disease (CHD) leads to an accelerated decline in estimated glomerular filtration rate (eGFR), a new study found.
For patients with a first-time heart failure hospitalization, the rate of eGFR decline increased significantly from ‐1.67 mL/min/1.73 m2 per year before the event to ‐2.76 mL/min/1.73 m2 per year after the event (a ‐1.09 mL/min/1.73 m2 difference). For patients hospitalized with CHD, eGFR decline increased significantly from ‐1.09 to ‐1.87 mL/min/1.73 m2 per year (a slope increase of ‐0.78 mL/min/1.73 m2). No acceleration in eGFR decline was observed among patients hospitalized with incident stroke, perhaps due to the relatively small sample size.
The accelerated declines in eGFR after heart failure and CHD were consistent across the spectrum of eGFR, Junichi Ishigami, MD, MPH, of Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and colleagues reported in the European Journal of Heart Failure. The rate of kidney function decline prior to hospitalization was steeper among patients with more advanced kidney disease. For example, patients with eGFRs of 60 or more, 30 to 59, and less than 30 mL/min/1.73 m2 in the 2 years prior to heart failure hospitalization had a baseline eGFR decline of ‐0.64, ‐1.43, and ‐2.42 mL/min/1.73 m2, respectively.
For the study, the investigators analyzed data from 20,420 patients hospitalized for the first time with heart failure, 18,152 with CHD, and 1808 with stroke from the Stockholm CREAtinine Measurements (SCREAM) Project in Sweden. The study excluded patients with end-stage kidney disease.
“From a clinical perspective, the incidence of CVD [cardiovascular disease] should be recognized as an event to accelerate kidney function decline regardless of the baseline kidney function. … Thus, physicians may need to be cautious about the use of potentially nephrotoxic drugs for these patients, especially when their clinical benefits are controversial (e.g., proton pump inhibitor),” Dr Ishigami’s team stated.
They added that their study “suggests the need for a long-term follow-up of kidney function evaluation after an episode of CVD, extending the notion on the prognostic importance of worsening kidney function during the acute CVD phase.”
The present study involved patients with symptoms serious enough to warrant hospitalization, so future studies should explore whether eGFR trajectory differs between inpatients and outpatients with worsening heart failure and CHD and whether avoiding hospitalization slows kidney disease progression, according to the investigators.
Ishigami J, Trevisan M, Lund L, et al. Acceleration of kidney function decline after incident hospitalization with cardiovascular disease: the Stockholm CREAtinine Measurements (SCREAM) project [published online July 19, 2020]. Eur J Heart Fail. doi: 10.1002/ejhf.1968