NEW research has shown that a decline in kidney function is a common and significant prognostic marker in patients with transthyretin amyloid cardiomyopathy (ATTR-CM), independently associated with increased mortality risk.
This retrospective cohort study assessed 2001 patients diagnosed with ATTR-CM at the National Amyloidosis Centre, UK, between 2000 and 2024. Kidney function was measured by the estimated glomerular filtration rate (eGFR) at baseline and after one year, defining significant decline as a reduction of more than 20%. The study aimed to evaluate the relationship between kidney function deterioration and all-cause mortality, adjusted for established disease progression markers.
Of the cohort, 481 patients (24.0%) experienced a significant decline in kidney function, with a median decrease in eGFR of −5 mL/min/1.73 m² (IQR −12 to 1). Patients with worsening kidney function were more likely to exhibit the p.(V142I) genotype and higher levels of cardiac biomarkers, indicating more severe cardiac involvement at baseline. Decline in kidney function was consistently linked to a 1.7-fold higher mortality risk (HR 1.71; 95% CI, 1.43–2.04; P < .001) across genotypes and disease stages. Importantly, this association persisted even after adjusting for increases in NT-proBNP levels and intensified outpatient diuretic regimens (adjusted HR 1.48; 95% CI, 1.23–2.76; P < .001).
These findings underscore the importance of regular kidney function monitoring in ATTR-CM management. Decline in eGFR is frequent, often signalling advanced disease progression independent of other clinical markers. Incorporating kidney function trends into routine assessments could improve risk stratification and guide timely intervention strategies. Future research should explore the mechanisms linking kidney dysfunction to ATTR-CM outcomes and investigate targeted therapies to mitigate this risk.
Reference
Ioannou A et al. Kidney outcomes in transthyretin amyloid cardiomyopathy. JAMA Cardiol. 2024;DOI:10.1001/jamacardio.2024.4578.
