Heart failure & cardiomyopathiesCohort study
Effect of Guideline-directed Medical Therapy (GDMT) Optimization on KDIGO Risk Categories in HFrEF
- registry
- Consecutive
- baseline and 12-month follow-up data
Authors' conclusion
KDIGO risk trajectories vary substantially during GDMT optimization in HFrEF. UACR provides complementary information beyond eGFR and may improve risk stratification for renal and HF outcomes.
Study context
- Population
- HFrEF outpatients from the VIENNA-HF registryConsecutive HFrEF outpatients with baseline and 12-month follow-up data
- Participants
- 234 outpatients
- Exposure
- KDIGO risk categories and trajectories following GDMT optimization, and their association with renal and heart failure (HF) outcomes
Main finding
As reported in the abstract
- GDMT dosages significantly increased
Observational data: associations, not effects.
Further findings
Estimated glomerular filtration rate (eGFR) · follow-up
- eGFR declined (baseline vs follow-up)
- 60 vs 56 mL/min/1.73 m²
- P = 0.007
Urine albumin-to-creatinine ratio (UACR) · follow-up
- UACR improved (baseline vs follow-up)
- 31 vs 24 mg/g
- P = 0.003
KDIGO trajectories
- stable
- 56%
- worsening
- 24%
- improved
- 20%
Renal events across baseline KDIGO risk classes · 2-years estimate
- Event rates increased stepwise across baseline KDIGO risk classes
- 4% vs 12% vs 15% vs 27%
- P < 0.001
HF events across baseline KDIGO risk classes · 2-years estimate
- Event rates increased stepwise across baseline KDIGO risk classes
- 19% vs 29% vs 37% vs 56%
- P < 0.001
Renal events by KDIGO trajectory · 2-year estimate
- worsening KDIGO trajectories were associated with higher event rates
- 6% vs 15% vs 21%
- P = 0.034
HF events by KDIGO trajectory · 2-year estimate
- worsening KDIGO trajectories were associated with higher event rates
- 11% vs 43% vs 46%
- P = 0.007
Reclassifications
- UACR sole determinant
- 35% of cases
- UACR contributed to over half of all reclassifications
Original publication
Summarised from the published abstract; every number is checked against it