Synergistic impact of baseline eGFR and longitudinal trajectory on clinical outcomes in pulmonary arterial hypertension
Q Wang, Q Luo, Z LiuAbstract
Background
Renal impairment is a robust risk factor for mortality prediction in pulmonary arterial hypertension, probably driven by the progressive remodeling of the pulmonary vasculature and subsequent right-heart cardio-renal syndrome. However, whether the synergistic integration of baseline and longitudinal eGFR trajectories enhances prognostic performance in PAH remains to be established.
Purpose
To investigate the synergistic prognostic value of baseline renal function and longitudinal eGFR trajectory in patients with PAH.
Method
A total of 346 patients diagnosed with PAH through right heart catheterization were enrolled in the retrospective study and stratified into quartiles based on baseline eGFR (mL/min/1.73 m²) levels during admission: ≤82.5 (n=87), 82.5-99.3 (n=87), 99.3-114 (n=86), >114 (n=86). Restricted cubic spline was used to assess the linearity of static and dynamic eGFR with clinical worsening. Multivariate Cox regression analysis was performed to evaluate the predictive performance of both baseline and dynamic eGFR on clinical outcomes of patients with PAH.
Results
Clinical worsening occurred in 24% of patients over a median follow-up of 2.25 years. An approximately reversely linear relationship can be observed in both static and dynamic eGFR when considering their association with clinical worsening. Receiver-operating characteristics curve analysis showed that the optimal cut-off of static and dynamic eGFR for predicting in-hospital death was 82.5 mL/min/1.73 m² and -13.62% respectively. Kaplan–Meier analysis showed that patients with eGFR≤82.5 mL/min/1.73 m² at the baseline and a reduction of more than 13.62% during follow-up had a higher rate of clinical worsening than other groups (log-rank=10.31, p<0.01). It was revealed by multivariate Cox analysis that patients with the worst renal function faced a 3.56-fold increased risk of adverse clinical outcomes compared to those with normal renal function [adjusted hazard ratio (aHR)=3.56 (95% CI: 1.15–11.05), P=0.028], after adjusted for age, sex, history of hypertension and diabetes mellitus and vulnerability of left heart dysfunction.
Conclusion
Integration of eGFR at baseline and during follow-up shows a synergetic impact on clinical worsening for patients with PAH, which identifies a high-risk cardiorenal phenotype, highlighting the right-heart cardiorenal axis as an alert for monitoring and critical management in PAH.RCSFor image description, please refer to the figure legend and surrounding text.KM analysisFor image description, please refer to the figure legend and surrounding text.