Predictors of developing renal dysfunction following diagnosis of transthyretin cardiac amyloidosis

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2024-06, Vol.47 (6), p.e24298-n/a
• Main Authors: McDonald, Malcolm L., Manla, Yosef, Sonnino, Alice, Alonso, Mileydis, Neicheril, Radhika K., Sanchez, Alejandro, Lafave, Gabrielle, Armas, Yelenis Seijo De, Camargo, Antonio Lewis, Uppal, Dipan, Handa, Armaan, Wolinsky, David, Rivera, Nina Thakkar, Velez, Mauricio, Baran, David A., Estep, Jerry D., Snipelisky, David
• Format: Article
• Language: English
• Subjects: Aged; Amyloid Neuropathies, Familial - complications; Amyloid Neuropathies, Familial - diagnosis; Amyloid Neuropathies, Familial - physiopathology; Amyloidosis; ATTR; Biopsy; cardiac amyloidosis; Cardiomyopathies - diagnosis; Cardiomyopathies - etiology; Cardiomyopathies - physiopathology; Cardiovascular disease; Clinical; Disease Progression; Ejection fraction; Female; Follow-Up Studies; Glomerular Filtration Rate; Glucose; Heart failure; Humans; Incidence; Ischemia; Kidney - physiopathology; Kidney diseases; Male; Middle Aged; Patients; Peptides; Prognosis; Regression analysis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - physiopathology; renal outcomes; Retrospective Studies; Risk Assessment - methods; Risk Factors; SGLT‐2 inhibitor; Time Factors
• ISSN: 0160-9289; 1932-8737; 1932-8737
• DOI: 10.1002/clc.24298

Background In patients with transthyretin cardiac amyloidosis (ATTR‐CA), renal dysfunction is a poor prognostic indicator. Limited data are available on variables that portend worsening renal function (wRF) among ATTR‐CA patients. Objectives This study assesses which characteristics place patients at higher risk for the development of wRF (defined as a drop of ≥10% in glomerular filtration rate [GFR]) within the first year following diagnosis of ATTR‐CA. Methods We included patients with ATTR‐CA (n = 134) evaluated between 2/2016 and 12/2022 and followed for up to 1 year at our amyloid clinic. Patients were stratified into two groups: a group with maintained renal function (mRF) and a group with wRF and compared using appropriate testing. Significant variables in the univariate analysis were included in the multivariable logistic regression model to determine characteristics associated with wRF. Results Within a follow‐up period of 326 ± 118 days, the median GFR% change measured −6% [−18%, +8]. About 41.8% (n = 56) had wRF, while the remainder had mRF. In addition, in patients with no prior history of chronic kidney disease (CKD), 25.5% developed de novo CKD. On multivariable logistic regression, only New York Heart Association (NYHA) class ≥III (odds ratio [OR]: 3.9, 95% confidence interval [CI]: [1.6–9.3]), history of ischemic heart disease (IHD) (OR: 0.3, 95% CI: [0.1–0.7]), and not receiving SGLT‐2i (OR: 0.1, 95% CI: [0.02–0.5]) were significant predictors of wRF. Conclusion Our study demonstrated that the development of de novo renal dysfunction or wRF is common following the diagnosis of ATTR‐CA. Additionally, we identified worse NYHA class and no prior history of IHD as significant predictors associated with developing wRF, while receiving SGLT‐2i therapy appeared to be protective in this population. Our study demonstrated that the development of de novo renal dysfunction or worsening renal function is common following the diagnosis of ATTR‐CA. Additionally, we identified worse NYHA class and no history of IHD as significant predictors associated with developing worsening renal function, while receiving SGLT2i therapy appeared to be protective.