Prognosis after >50% decline in eGFR in heart failure patients: a nationwide real-world study (original) (raw)

Anjum, Deewa Zahir, Elmegaard, Mariam, Garred, Caroline Hartwell, Nouhravesh, Nina, Fosbol, Emil, Jhund, Pardeep S. ORCID: https://orcid.org/0000-0003-4306-5317, McMurray, John J.V. ORCID: https://orcid.org/0000-0002-6317-3975, Petrie, Mark C. ORCID: https://orcid.org/0000-0002-6333-9496, Køber, Lars and Schou, Morten(2025) Prognosis after >50% decline in eGFR in heart failure patients: a nationwide real-world study.JACC: Heart Failure, 13(8), 102481. (doi: 10.1016/j.jchf.2025.02.027) (PMID:40591985)

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Abstract

Background: A 50% decline in estimated glomerular filtration rate (eGFR) has been introduced as a new kidney endpoint in heart failure (HF) trials. However, its prognostic significance beyond the initial 6 months following HF diagnosis, during which patients often undergo medical therapy optimization, remains uncertain—particularly for patients without diabetes. Objectives: This study aims to determine the long-term prognostic implications of eGFR decline focusing on risks for all-cause mortality and end-stage kidney disease (ESKD). Methods: The authors conducted a nationwide cohort study of all new-onset patients diagnosed with HF between 2014 and 2021. eGFR trajectory was assessed from months 6 to 12 post-diagnosis categorizing patients into 3 groups: stable eGFR (<25% decline), 25%-50% decline, and >50% decline. Only patients who survived the first year post-diagnosis were included in the landmark analysis with the primary outcomes of all-cause mortality and ESKD. Results: Among 45,385 patients with HF (median age: 73.6, 63.8% male), 82.5% had stable eGFR, 14.2% had a 25%-50% decline, and 3.3% had >50% decline at 1 year. In patients without diabetes, eGFR decline >25% was associated with increased 5-year mortality, with absolute risks of 33.2%, 53.8%, and 63.0% for stable eGFR, 25%-50% decline, and >50% decline, respectively. In patients with diabetes, absolute mortality risk was generally higher but followed the same trend (42.8%, 58.6%, and 65.6% for stable eGFR, 25%-50% decline, and >50% decline, respectively). The risk of developing ESKD also increased with eGFR decline. In patients without diabetes, absolute risks were 3.3%, 7.9%, and 11.5% for stable eGFR, 25%-50% decline, and >50% decline, respectively, whereas the absolute risk of ESKD was notably higher in patients with diabetes (7.4%, 15.6%, and 21.1% for stable eGFR, 25%-50% decline, and >50% decline, respectively). Conclusions: In this large real-world study, a >50% eGFR decline was associated with increased mortality and ESKD risk irrespective of diabetes status, underscoring its clinical relevance.

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