Abstract MP34: Acceleration of Kidney Function Decline After Incident Hospitalization With Cardiovascular Disease: The Stockholm Creatinine Measurements (scream) Project

Abstract

Background: The cardiorenal syndrome suggests a bidirectional relationship between worsening kidney function and cardiac dysfunction. However, to our knowledge, no studies have quantified changes in slopes of kidney function decline before and after the incidence of major cardiovascular disease (CVD) subtypes. Methods: We compared the individual slopes of estimated glomerular filtration rate (eGFR) decline in the 2 years before vs. after the incident hospitalization with heart failure (HF) (n=20,420), coronary heart disease (CHD) (n=18,152), and stroke (n=1,808) using data from the complete laboratory data collection of Stockholm healthcare (Sweden) between 2006 and 2011. Using mixed effect models with unstructured residual correlation matrix, we examined changes in individual slopes of eGFR decline before and after incident CVD in the overall population, and by index eGFR strata (≥60, 30-59, <30 ml/min/1.73m 2 ). Results: Incident hospitalization with HF and CHD, but not stroke, was significantly associated with a subsequent acceleration of eGFR decline, with a faster eGFR decline and greater slope change after HF than CHD. The pre-event vs. post-event eGFR slope (ml/min/1.73m 2 per year) were -1.67 (-1.77 to -1.57) vs. -2.76 (-2.82 to -2.71), with Δslope of -1.09 (-1.16 to -1.02) for HF; -1.09 (-1.20 to -0.98) vs. -1.87 (-1.92 to -1.81), with Δslope of -0.78 (-0.85 to -0.70) for CHD; and -1.00 (-1.37 to -0.63) vs. -0.99 (-1.19 to -0.78), with , Δslope of 0.02 (-0.24 to 0.27) for stroke ( Figure ). The accelerated eGFR declines after HF and CHD were consistently observed across eGFR strata, with pre-event eGFR slopes steeper in lower eGFR (e.g., pre-event eGFR slope for HF -0.64 (-0.76 to -0.53) for eGFR ≥60, -1.43 (-1.57 to -1.30) for eGFR 30-59, and -2.42 (-2.71 to -2.12) for eGFR <30 ml/min/1.73m 2 ). Conclusions: Incident hospitalization with cardiac diseases (ie, HF and CHD) was significantly associated with a subsequent acceleration of eGFR decline.