Performance Of The MELDXI Score In A Modern Left Ventricular Assist Device Cohort
HFSA ePoster Library. Stawiarski K. 09/10/21; 343437; 206
Kristin Stawiarski
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Abstract
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Introduction: Cardiovascular and kidney disease are closely inter-related. In EMPA-REG OUTCOME, empagliflozin (10 or 25mg once daily) reduced the risk of hospitalization for heart failure (HHF) and kidney events in patients with type 2 diabetes and established cardiovascular (CV) disease.
Hypothesis: We evaluated whether kidney events increase risk for subsequent HF or CV outcomes and vice versa.
Methods: Bi-directional associations of kidney events and subsequent CV events were explored using Cox regression with time-varying covariates.
Results: Of 2,061 placebo patients, 18.8% experienced a kidney event (progression to macroalbuminuria with urine albumin-creatinine ratio [UACR] >300mg/g, doubling of serum creatinine with estimated glomerular filtration rate [eGFR] ≤45 ml/min/1.73 m2, initiation of renal-replacement therapy or renal death). Factors significantly associated with risk of experiencing a kidney event included: low baseline eGFR, albuminuria ≥30mg/g, high uric acid and LDL-C, prior HF but no coronary artery disease. In placebo patients, occurrence of a non-fatal kidney event increased subsequent HHF risk (hazard ratio [95% CI]) (2.40 [1.42,4.05]) but not 3P-MACE (1.30 [0.89,1.91]) (panel A). Vice versa, HHF (2.03 [1.22,3.39]) but not myocardial infarction (MI)/stroke (0.94 [0.56,1.56]) increased subsequent kidney event risk in the placebo arm (panel B). For 3-P MACE following kidney event, risk was significantly increased in the empagliflozin and overall groups although to a lesser extent and not significant from placebo (panel A).
Conclusions: These findings demonstrate strong bi-directional inter-relationship between HHF and kidney events. Strategies to optimize the use of therapies such as empagliflozin, reducing both kidney and HF outcomes, are warranted, as their benefits may be compounded.
Hypothesis: We evaluated whether kidney events increase risk for subsequent HF or CV outcomes and vice versa.
Methods: Bi-directional associations of kidney events and subsequent CV events were explored using Cox regression with time-varying covariates.
Results: Of 2,061 placebo patients, 18.8% experienced a kidney event (progression to macroalbuminuria with urine albumin-creatinine ratio [UACR] >300mg/g, doubling of serum creatinine with estimated glomerular filtration rate [eGFR] ≤45 ml/min/1.73 m2, initiation of renal-replacement therapy or renal death). Factors significantly associated with risk of experiencing a kidney event included: low baseline eGFR, albuminuria ≥30mg/g, high uric acid and LDL-C, prior HF but no coronary artery disease. In placebo patients, occurrence of a non-fatal kidney event increased subsequent HHF risk (hazard ratio [95% CI]) (2.40 [1.42,4.05]) but not 3P-MACE (1.30 [0.89,1.91]) (panel A). Vice versa, HHF (2.03 [1.22,3.39]) but not myocardial infarction (MI)/stroke (0.94 [0.56,1.56]) increased subsequent kidney event risk in the placebo arm (panel B). For 3-P MACE following kidney event, risk was significantly increased in the empagliflozin and overall groups although to a lesser extent and not significant from placebo (panel A).
Conclusions: These findings demonstrate strong bi-directional inter-relationship between HHF and kidney events. Strategies to optimize the use of therapies such as empagliflozin, reducing both kidney and HF outcomes, are warranted, as their benefits may be compounded.
Introduction: Cardiovascular and kidney disease are closely inter-related. In EMPA-REG OUTCOME, empagliflozin (10 or 25mg once daily) reduced the risk of hospitalization for heart failure (HHF) and kidney events in patients with type 2 diabetes and established cardiovascular (CV) disease.
Hypothesis: We evaluated whether kidney events increase risk for subsequent HF or CV outcomes and vice versa.
Methods: Bi-directional associations of kidney events and subsequent CV events were explored using Cox regression with time-varying covariates.
Results: Of 2,061 placebo patients, 18.8% experienced a kidney event (progression to macroalbuminuria with urine albumin-creatinine ratio [UACR] >300mg/g, doubling of serum creatinine with estimated glomerular filtration rate [eGFR] ≤45 ml/min/1.73 m2, initiation of renal-replacement therapy or renal death). Factors significantly associated with risk of experiencing a kidney event included: low baseline eGFR, albuminuria ≥30mg/g, high uric acid and LDL-C, prior HF but no coronary artery disease. In placebo patients, occurrence of a non-fatal kidney event increased subsequent HHF risk (hazard ratio [95% CI]) (2.40 [1.42,4.05]) but not 3P-MACE (1.30 [0.89,1.91]) (panel A). Vice versa, HHF (2.03 [1.22,3.39]) but not myocardial infarction (MI)/stroke (0.94 [0.56,1.56]) increased subsequent kidney event risk in the placebo arm (panel B). For 3-P MACE following kidney event, risk was significantly increased in the empagliflozin and overall groups although to a lesser extent and not significant from placebo (panel A).
Conclusions: These findings demonstrate strong bi-directional inter-relationship between HHF and kidney events. Strategies to optimize the use of therapies such as empagliflozin, reducing both kidney and HF outcomes, are warranted, as their benefits may be compounded.
Hypothesis: We evaluated whether kidney events increase risk for subsequent HF or CV outcomes and vice versa.
Methods: Bi-directional associations of kidney events and subsequent CV events were explored using Cox regression with time-varying covariates.
Results: Of 2,061 placebo patients, 18.8% experienced a kidney event (progression to macroalbuminuria with urine albumin-creatinine ratio [UACR] >300mg/g, doubling of serum creatinine with estimated glomerular filtration rate [eGFR] ≤45 ml/min/1.73 m2, initiation of renal-replacement therapy or renal death). Factors significantly associated with risk of experiencing a kidney event included: low baseline eGFR, albuminuria ≥30mg/g, high uric acid and LDL-C, prior HF but no coronary artery disease. In placebo patients, occurrence of a non-fatal kidney event increased subsequent HHF risk (hazard ratio [95% CI]) (2.40 [1.42,4.05]) but not 3P-MACE (1.30 [0.89,1.91]) (panel A). Vice versa, HHF (2.03 [1.22,3.39]) but not myocardial infarction (MI)/stroke (0.94 [0.56,1.56]) increased subsequent kidney event risk in the placebo arm (panel B). For 3-P MACE following kidney event, risk was significantly increased in the empagliflozin and overall groups although to a lesser extent and not significant from placebo (panel A).
Conclusions: These findings demonstrate strong bi-directional inter-relationship between HHF and kidney events. Strategies to optimize the use of therapies such as empagliflozin, reducing both kidney and HF outcomes, are warranted, as their benefits may be compounded.
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