Kidney Outcomes in Transthyretin Amyloid Cardiomyopathy

doi:10.1001/jamacardio.2024.4578

Heart failure & cardiomyopathiesCohort study

Kidney Outcomes in Transthyretin Amyloid Cardiomyopathy

JAMA CardiolPublished 1 Jan 2025

Retrospective cohort study
single-centre
observational

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Authors' conclusion

In this retrospective cohort study, decline in kidney function was frequent in patients with ATTR-CM and was consistently associated with an increased risk of mortality, even after adjusting for established markers of worsening ATTR-CM.

Study context

Population: Patients with ATTR-CM at the National Amyloidosis Centre, UK, with baseline and 1-year estimated glomerular filtration rate (eGFR), 2000–2024
Participants: 2,001 patients

Exposure: Decline in kidney function vs stable kidney function
Decline in kidney functionn = 481
Outcome: All-cause mortality associated with decline in kidney function (eGFR decrease >20%)

Main finding

All-cause mortality

Hazard ratio

1.71

95% CI 1.43–2.04

P < 0.001

Decline in kidney function vs Stable kidney function

HR 1.71 (95% CI 1.43–2.04); P < 0.001

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	Lower risk with decline in kidney function ←→ Higher risk with decline in kidney function	HR (95% CI)	P value
Mortality by genotype (subgroup) · wild type		1.64 (1.31–2.04)
Mortality by genotype (subgroup) · p.(V142I)		1.70 (1.21–2.39)
Mortality by genotype (subgroup) · non-p.(V142I)		1.51 (0.87–2.61)
Mortality by NAC disease stage (subgroup) · stage 1		1.69 (1.22–2.32)
Mortality by NAC disease stage (subgroup) · stage 2		1.69 (1.30–2.18)
Mortality by NAC disease stage (subgroup) · stage 3		1.61 (1.11–2.35)
Mortality adjusted for increases in NT-proBNP and outpatient diuretic intensification		1.48 (1.23–2.76)	P < 0.001
	0.20.5125Hazard ratio (log scale)

p.(V142I) genotype

Decline in kidney function20.6%

Stable kidney function13.3%

Baseline NT-proBNP

Decline in kidney functionmedian 2949 pg/mLIQR 1759–5182

Stable kidney functionmedian 2309 pg/mLIQR 1146–4290

Baseline troponin T

Decline in kidney functionmedian 0.060 ng/mLIQR 0.042–0.086

Stable kidney functionmedian 0.052 ng/mLIQR 0.033–0.074

Baseline eGFR

Decline in kidney functionmedian 63 mL/min/1.73 m²IQR 51–77

Stable kidney functionmedian 61 mL/min/1.73 m²IQR 49–77

Mortality by genotype (subgroup): P for interaction = .93
Mortality by National Amyloidosis Centre (NAC) disease stage (subgroup): P for interaction = .97
p.(V142I) genotype: P < .001
Baseline NT-proBNP: P < .001
Baseline troponin T: P < .001
Baseline eGFR: P = .41

Change in eGFR at 1 year

Median (IQR) change in eGFR, all patients: −5 mlL/min/1.73 m² (−12 to 1)

Original publication

Kidney Outcomes in Transthyretin Amyloid Cardiomyopathy. JAMA Cardiol. Published 1 January 2025. doi:10.1001/jamacardio.2024.4578

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Summarised from the published abstract; every number is checked against it