Kohansal Karim, Abdi Amir, Khalili Davood, Hadaegh Farzad
Prevention of Metabolic Disorders Research Center, Research Institute for Metabolic and Obesity Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Prevention of Metabolic Disorders Research Center, Research Institute for Metabolic and Obesity Disorders, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Am J Kidney Dis. 2025 Jun;85(6):727-736.e1. doi: 10.1053/j.ajkd.2025.01.011. Epub 2025 Mar 5.
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).
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).
eGFR slope, estimated from eGFR measurements between visits 1 and 5 using linear mixed-effects models.
Incident clinical HF based on hospitalization ICD-9/10 codes.
Cause-specific hazard models.
The mean age of study participants 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 1mL/min/1.73m 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 nonlinearity=0.02). Compared with individuals with a moderate-to-high decline in eGFR (-1.87 to-1.25mL/min/1.73m per year), individuals in stage B with a steeper eGFR slope (<-1.87mL/min/1.73m 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 the eGFR slope was greater than-1.25mL/min/1.73m per year.
The eGFR slope may not fully capture the complexity of kidney function decline because it may not account for the fluctuating patterns.
The eGFR slope may be a valuable measurement to identify individuals at high risk of developing HF, particularly HFpEF.
PLAIN-LANGUAGE SUMMARY: Heart failure (HF) is a prevalent condition in older people, and its occurrence may be affected by kidney function. This study examined the relationship between changes in kidney function assessed by the slope of estimated glomerular filtration rate (eGFR) and the incidence of clinically diagnosed HF. We monitored more than 5,000 older people who were either at elevated risk for HF (stage A) or had cardiac abnormalities of HF (stage B) but had not yet developed clinical HF. Our findings indicated that among individuals in stage B a more rapid decline in kidney function was associated with a greater risk of developing HF, in particular HF with preserved ejection fraction (HFpEF). These findings highlight the potential value of tracking changes in kidney function to identify people at elevated risk of HF.
估算肾小球滤过率（eGFR）斜率对心力衰竭（HF）进展的影响尚不清楚。本研究调查了eGFR斜率与老年人心力衰竭发生风险增加或存在心脏异常（结构、血流动力学或生物标志物异常）（心力衰竭前期）的老年人发生HF的相关性。
前瞻性队列研究。
社区动脉粥样硬化风险研究中5362名在第5次访视时无HF的参与者（心力衰竭风险增加[A期]：n = 1262；存在心脏异常[B期]：n = 4100）。
使用线性混合效应模型根据第1次和第5次访视之间的eGFR测量值估算的eGFR斜率。
基于住院ICD - 9/10编码的新发临床HF。
特定病因风险模型。
研究参与者的平均年龄为75.7岁，58.4%为女性，中位随访时间超过6年。在A期个体中未发现显著关联。在B期，eGFR斜率每每年下降1mL/min/1.73m²与HF风险较高相关（HR，1.39[95%CI，1.11 - 1.73]）。多变量调整后的三次样条分析表明，这种关联在B期个体中是非线性的（P非线性 = 0.02）。与eGFR中度至高度下降（每年 - 1.87至 - 1.25mL/min/1.73m²）的个体相比，B期eGFR斜率更陡（< - 1.87mL/min/1.73m²每年）的个体发生HF的风险增加（HR，1.58[95%CI，1.20 - 2.10]）。B期更陡的eGFR斜率也与射血分数保留的心力衰竭（HFpEF）显著相关（HR，1.54[95%CI，1.10 - 2.17]）。在B期个体中，当eGFR斜率大于每年 - 1.25mL/min/1.73m²时，未发现新发临床HF风险有明显升高。
eGFR斜率可能无法完全捕捉肾功能下降的复杂性，因为它可能无法解释波动模式。
eGFR斜率可能是识别发生HF高风险个体，特别是HFpEF个体的有价值指标。
心力衰竭（HF）在老年人中很常见，其发生可能受肾功能影响。本研究调查了通过估算肾小球滤过率（eGFR）斜率评估的肾功能变化与临床诊断HF发病率之间的关系。我们监测了5000多名心力衰竭风险增加（A期）或有心力衰竭心脏异常（B期）但尚未发生临床HF的老年人。我们的研究结果表明，在B期个体中，肾功能下降更快与发生HF的风险更高相关，特别是射血分数保留的心力衰竭（HFpEF）。这些发现突出了追踪肾功能变化以识别HF风险增加人群的潜在价值。
