Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Eur J Heart Fail. 2022 Oct;24(10):1906-1914. doi: 10.1002/ejhf.2638. Epub 2022 Aug 15.
Worsening renal function may impact long-term outcomes in heart failure (HF). However, little is known about the longitudinal trajectories in renal function in relation to HF hospitalization or how this high-risk clinical event impacts renal outcomes.
In PARAGON-HF, we evaluated the association between recency of prior HF hospitalization (occurring pre-randomization) and subsequent first renal composite outcome: (i) time to ≥50% decline in estimated glomerular filtration rate (eGFR); (ii) development of end-stage renal disease; or (iii) death attributable to renal causes. A total of 2306 (48.1%) patients had a history of prior HF hospitalization. Incident rates of the renal outcome were highest in those most recently hospitalized and decreased with longer time from last hospitalization. Treatment effect on the renal outcome of sacubitril/valsartan versus valsartan was similar between patients with (hazard ratio [HR] 0.43; 95% confidence interval [CI] 0.24-0.76) and without (HR 0.63; 95% CI: 0.33-1.18; p = 0.39) a prior history of HF hospitalization and appeared consistent regardless of timing of prior hospitalization for HF (p = 0.39). Serial eGFR measurements leading up to and after a HF hospitalization (occurring during the study period) and estimated eGFR trajectories using repeated measures regression models with restricted cubic splines were also examined. Patients experiencing a post-randomization HF hospitalization had a significant decline in eGFR prior to hospitalization while patients without HF hospitalization experienced a relatively stable eGFR trajectory (p < 0.001). A change in the rate of decline of eGFR trajectory was observed 12 months preceding a HF hospitalization, and continued in the post-discharge window to 12 months following hospitalization.
Heart failure hospitalization denotes increased risk for kidney disease progression which continues following recovery from HF decompensation in patients with HF with preserved ejection fraction.
PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction), ClinicalTrials.gov NCT01920711.
肾功能恶化可能会影响心力衰竭（HF）患者的长期预后。然而，关于 HF 住院与肾功能的纵向变化轨迹以及这种高危临床事件如何影响肾脏结局的信息知之甚少。
在 PARAGON-HF 中，我们评估了近期 HF 住院（发生在随机分组前）与随后发生的第一个肾脏复合结局之间的关系：（i）估算肾小球滤过率（eGFR）下降≥50%的时间；（ii）终末期肾病的发生；或（iii）由肾脏原因引起的死亡。共有 2306 例（48.1%）患者有 HF 住院史。在最近一次住院的患者中，肾脏结局的发生率最高，并且随着距上次住院时间的延长而降低。与没有 HF 住院史的患者相比，沙库巴曲缬沙坦与缬沙坦治疗对肾脏结局的影响在有 HF 住院史的患者中相似（风险比[HR]0.43；95%置信区间[CI]0.24-0.76）和没有 HF 住院史的患者中相似（HR 0.63；95%CI：0.33-1.18；p=0.39），且与 HF 住院的时间无关（p=0.39）。还检查了 HF 住院前后（研究期间发生）的连续 eGFR 测量值以及使用重复测量回归模型和限制立方样条估计的估计 eGFR 轨迹。经历随机分组后 HF 住院的患者在住院前 eGFR 显著下降，而没有 HF 住院的患者 eGFR 轨迹相对稳定（p<0.001）。在 HF 住院前 12 个月观察到 eGFR 轨迹下降率的变化，并且在出院后 12 个月的窗口内持续。
HF 住院表明，射血分数保留的心力衰竭患者在 HF 失代偿恢复后，肾脏疾病进展的风险增加。
PARAGON-HF（ARNI 与 ARB 全球在射血分数保留的心力衰竭中的疗效比较试验），ClinicalTrials.gov 注册号：NCT01920711。
