GDMT in HFrEF decreased eGFR (59 to 56 ml/min/1.73m², p=0.003) and improved albuminuria (UACR 29 to 25 mg/g, p=0.011) over one year.
Does GDMT up-titration improve albuminuria and eGFR in patients with HFrEF?
GDMT up-titration in HFrEF is associated with a slight decline in eGFR but an improvement in albuminuria, particularly in those with moderate to severe albuminuria.
Absolute Event Rate: 0% vs 0%
Abstract Background Heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) are closely linked. Albuminuria is an independent risk marker for worse outcomes in both diseases. While guideline-directed medical therapy (GDMT) often leads to an initial, acceptable rise in serum creatinine, it helps stabilize kidney function over time. However, the effects of GDMT on albuminuria vary. The dynamics of estimated glomerular filtration rate (eGFR) and albuminuria during dedicated GDMT up-titration remains poorly characterized. Purpose This study aimed to assess the impact of GDMT up-titration on eGFR and albuminuria in patients with HFrEF over the course of one year. Methods A total of 247 patients with HFrEF with complete baseline (BL), i.e. first presentation, and 1-year follow-up data were included from our outpatient HFrEF registry. Patient characteristics, medications and laboratory parameters were documented. Patients were categorized according to the 2024 KDIGO CKD classification based on eGFR and urine albumin-creatinine ratio (UACR). Changes in eGFR and UACR were analyzed during GDMT up-titration. Results Up-titration of HF medications was successful; target doses (TDs) of all recommended HF medications increased significantly during follow-up (BL vs 1-year, p0.001 for all) whereas the majority of patients received ≥50% of the recommended TDs at 1-year (86% for BB, 89% for RASi and 89% for MRA) (Figure 1A). GDMT implementation was accompanied by a significant decrease in NT-proBNP (BL vs 1-year: 1968 702-5014 vs 882 234-3083 pg/ml, p0.001) and an increase in renin (BL vs 1-year: 163 30-673 vs 194 37-751 µlU/ml, p=0.012). Overall, eGFR but also UACR decreased significantly (eGFR: BL vs 1-year: 59 39-74 vs 56 35-73 ml/min/1.73m2, p=0.003; UACR: BL vs 1-year: 29 12-101 vs 25 10-75 mg/g, p=0.011) (Figure 1B). Figure 2 depicts the estimated risk categories and changes of eGFR and UACR according to the CKD categories. A decrease in eGFR was most evident in the subgroup of patients with high eGFR (p=0.001 for G1 and p=0.007 for G2) or mild albuminuria, while an improvement in albuminuria was observed for both moderate and severe albuminuria (p=0.032 for A2 and p0.001 for A3) and worse eGFR (Figure 2B). With the combination of effects patient´s risk categories according to the KDIGO 2024 classification did not change significantly after the implementation of GDMT (Figure 2A). Conclusions GDMT implementation in HFrEF results in a decline in eGFR alongside an improvement in UACR. The eGFR reduction is most pronounced in patients with mild CKD, while albuminuria improves in both moderate and severe albuminuria. However, these combined effects do not lead to a lower KDIGO risk classification. The effect on kidney and cardiovascular outcomes needs to be assessed for subgroups.
Panagiotides et al. (Sat,) reported a other. GDMT in HFrEF decreased eGFR (59 to 56 ml/min/1.73m², p=0.003) and improved albuminuria (UACR 29 to 25 mg/g, p=0.011) over one year.