Mitral regurgitation linked to heightened risk of CKD in patients with heart failure
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Key takeaways:
- Patients in a study with heart failure who identified as having mitral regurgitation saw a doubling of creatinine.
- Of the 600 patients in the study, 71 had moderate or severe mitral regurgitation.
LONG BEACH, Calif. — Patients with heart failure who also experienced mitral regurgitation saw a doubling of their creatinine, according to data presented here.
“Reduced kidney function is an important risk factor for adverse outcomes among patients with heart failure with preserved ejection fraction (HFpEF),” Katie Ferguson, MS, of Tufts Medical Center in Boston, and colleagues wrote in a poster presented at the National Kidney Foundation Spring Clinical Meetings. “While the presence of severe mitral regurgitation (MR) is associated with adverse cardiovascular outcomes, its association with long-term kidney function is unknown in HFpEF,” they wrote.
Researchers performed a post-hoc analysis of the Aldosterone Antagonist Therapy for Adults with Heart Failure and Preserved Systolic Function (TOPCAT) trial, which randomized patients with HFpEF to spironolactone vs. placebo. “The exposure of interest was MR, treated as a binary variable (moderate or severe vs. no, trivial or mild). Kaplan-Meier and Cox regression analyses were performed to evaluate the associations of moderate or severe MR with time to creatinine doubling,” the researchers wrote.
The study included 600 patients; in this group, 71, or 11.8%, had moderate or severe MR. During a median follow-up of 3 years, creatinine doubling was seen in 57 (9.5%) patients in the study. “Moderate or severe MR was associated with significantly higher risk of creatinine doubling in univariate and multivariable analyses,” Ferguson and colleagues wrote.
In an interview with Healio, Wendy McCallum, MD, a co-author on the poster, said the connection between MR and decline in chronic kidney disease remains unclear. “We tend to consider mitral regurgitation as a volume-mediated problem, at least in certain subtypes of patients with heart failure and mitral regurgitation,” McCallum said. “ ... I would speculate that perhaps we are identifying the patients struggling with issues of volume overload, which are manifesting as severe to moderate mitral regurgitation, as well as higher risk of declines in kidney function,” she said.
McCallum confirmed that the researchers saw a 40% decline in eGFR “in a somewhat strict manner for this analysis by requiring a confirmatory test, given what we understand of all the fluctuations in eGFR among patients with heart failure,” she told Healio. “My speculation is that we eliminated the patients with large fluctuations perhaps due to changes in hemodynamics, but we will need to examine that further.
McCallum said examining kidney endpoints “using either data from the randomized clinical trials of repair of mitral regurgitation vs. medical management or data from clinical registries of patients who undergo mitral regurgitation repair would be informative next steps.”
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Ferguson K, et al. Poster 225. Presented at: NKF Spring Clinical Meetings; May 14-18, 2024; Long Beach, Calif.
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