Abstract 11968: Association of Invasive Measures of Congestion With Short- and Long-Term Kidney Function Outcomes Among Patients With Acute Decompensated Heart Failure

Abstract

Background: Reduced kidney function as evaluated by estimated glomerular filtration rate (eGFR) is a powerful risk factor for adverse outcomes among patients with acute decompensated heart failure (ADHF). Mechanisms for eGFR declines remain unclear. Studies evaluating congestion as a risk factor have been inconsistent. Hypothesis: Greater degree of congestion in patients with ADHF is associated with worse short- and long-term kidney function. Methods: We examined patients admitted for ADHF who required right heart catheterization from 2015-2021. Initial CVP and PCWP were used as measures of right- and left-sided congestion, respectively. Restricted cubic splines and linear mixed models for eGFR slopes were used to examine the relation between CVP and PCWP with baseline eGFR and in-hospital eGFR slope. End stage renal disease (ESRD) events were obtained from linkage to the US Renal Data System. Cox proportional hazards regression models were used to examine the relation of CVP and PCWP with mortality and ESRD. Results: Among 755 patients, the mean (SD) age and baseline eGFR were 62 (14) years and 58 (27) ml/min/1.73m 2 respectively. 440 (58%) required inotropes during hospitalization. Initial mean (SD) CVP and PCWP were 13.4 (6.6) and 23.4 (8.7) mmHg, respectively. Higher initial CVP and PCWP were significantly associated with lower baseline eGFR and in-hospital eGFR decline (Figure). Over median follow-up of 30 (IQR 10, 56) months, 62 (8.2%) reached ESRD and 264 (35%) died. In multivariable models, higher CVP and PCWP were each associated with increased risk for ESRD (HR [95%CI] per 1 SD higher CVP or PCWP were 1.49 [1.17, 1.91]; 1.30 [1.04, 1.64] respectively). Models were repeated with death as a competing event for ESRD and associations remained largely consistent (sHR 1.36 [1.03, 1.81] for CVP; sHR 1.25 [0.99, 1.57] for PCWP). Conclusion: Congestion is associated with lower baseline kidney function, greater acute declines in kidney function and increased risk of ESRD.