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Abstract：
BACKGROUND: In patients with transthyretin cardiac amyloidosis (ATTR-CA), renal dysfunction is a poor prognostic indicator. Limited data are available on variables that portend worsening renal function (wRF) among ATTR-CA patients.
OBJECTIVE: This study assesses which characteristics place patients at higher risk for the development of wRF (defined as a drop of ≥10% in glomerular filtration rate [GFR]) within the first year following diagnosis of ATTR-CA.
METHODS: We included patients with ATTR-CA (n = 134) evaluated between 2/2016 and 12/2022 and followed for up to 1 year at our amyloid clinic. Patients were stratified into two groups: a group with maintained renal function (mRF) and a group with wRF and compared using appropriate testing. Significant variables in the univariate analysis were included in the multivariable logistic regression model to determine characteristics associated with wRF.
RESULTS: Within a follow-up period of 326 ± 118 days, the median GFR% change measured -6% [-18%, +8]. About 41.8% (n = 56) had wRF, while the remainder had mRF. In addition, in patients with no prior history of chronic kidney disease (CKD), 25.5% developed de novo CKD. On multivariable logistic regression, only New York Heart Association (NYHA) class ≥III (odds ratio [OR]: 3.9, 95% confidence interval [CI]: [1.6-9.3]), history of ischemic heart disease (IHD) (OR: 0.3, 95% CI: [0.1-0.7]), and not receiving SGLT-2i (OR: 0.1, 95% CI: [0.02-0.5]) were significant predictors of wRF.
CONCLUSIONS: Our study demonstrated that the development of de novo renal dysfunction or wRF is common following the diagnosis of ATTR-CA. Additionally, we identified worse NYHA class and no prior history of IHD as significant predictors associated with developing wRF, while receiving SGLT-2i therapy appeared to be protective in this population.
OBJECTIVE: This study assesses which characteristics place patients at higher risk for the development of wRF (defined as a drop of ≥10% in glomerular filtration rate [GFR]) within the first year following diagnosis of ATTR-CA.
METHODS: We included patients with ATTR-CA (n = 134) evaluated between 2/2016 and 12/2022 and followed for up to 1 year at our amyloid clinic. Patients were stratified into two groups: a group with maintained renal function (mRF) and a group with wRF and compared using appropriate testing. Significant variables in the univariate analysis were included in the multivariable logistic regression model to determine characteristics associated with wRF.
RESULTS: Within a follow-up period of 326 ± 118 days, the median GFR% change measured -6% [-18%, +8]. About 41.8% (n = 56) had wRF, while the remainder had mRF. In addition, in patients with no prior history of chronic kidney disease (CKD), 25.5% developed de novo CKD. On multivariable logistic regression, only New York Heart Association (NYHA) class ≥III (odds ratio [OR]: 3.9, 95% confidence interval [CI]: [1.6-9.3]), history of ischemic heart disease (IHD) (OR: 0.3, 95% CI: [0.1-0.7]), and not receiving SGLT-2i (OR: 0.1, 95% CI: [0.02-0.5]) were significant predictors of wRF.
CONCLUSIONS: Our study demonstrated that the development of de novo renal dysfunction or wRF is common following the diagnosis of ATTR-CA. Additionally, we identified worse NYHA class and no prior history of IHD as significant predictors associated with developing wRF, while receiving SGLT-2i therapy appeared to be protective in this population.
摘要：
背景：在甲状腺素运载蛋白心脏淀粉样变性（ATTR-CA）患者中，肾功能不全是预后不良的指标.关于ATTR-CA患者中预示肾功能恶化(wRF)的变量的可用数据有限。
目的：本研究评估哪些特征使患者在确诊ATTR-CA后的第一年内发生wRF（定义为肾小球滤过率[GFR]下降≥10%）的风险更高。
方法：我们纳入了在2016年2月至2022年12月12日之间评估的ATTR-CA患者（n=134），并在我们的淀粉样蛋白诊所随访长达1年。将患者分为两组：维持肾功能（mRF）的组和使用wRF的组，并使用适当的测试进行比较。单变量分析中的重要变量包括在多变量逻辑回归模型中，以确定与wRF相关的特征。
结果：在326±118天的随访期内，测量的GFR%变化中位数-6%[-18%，+8].约41.8%(n=56)患有wRF，而其余的则有mRF。此外,在没有慢性肾脏病（CKD）病史的患者中，25.5%从头发展为CKD。在多变量逻辑回归中，仅纽约心脏协会（NYHA）等级≥III（比值比[OR]：3.9，95％置信区间[CI]：[1.6-9.3]），缺血性心脏病史（IHD）（OR：0.3，95%CI：[0.1-0.7]），和未接受SGLT-2i(OR:0.1,95%CI:[0.02-0.5])是wRF的显著预测因子。
结论：我们的研究表明，在诊断为ATTR-CA后，从头肾功能不全或wRF的发展是常见的。此外,我们发现更差的NYHA等级和之前没有IHD病史是与发展WRF相关的重要预测因子，虽然接受SGLT-2i治疗似乎对该人群具有保护作用。
目的：本研究评估哪些特征使患者在确诊ATTR-CA后的第一年内发生wRF（定义为肾小球滤过率[GFR]下降≥10%）的风险更高。
方法：我们纳入了在2016年2月至2022年12月12日之间评估的ATTR-CA患者（n=134），并在我们的淀粉样蛋白诊所随访长达1年。将患者分为两组：维持肾功能（mRF）的组和使用wRF的组，并使用适当的测试进行比较。单变量分析中的重要变量包括在多变量逻辑回归模型中，以确定与wRF相关的特征。
结果：在326±118天的随访期内，测量的GFR%变化中位数-6%[-18%，+8].约41.8%(n=56)患有wRF，而其余的则有mRF。此外,在没有慢性肾脏病（CKD）病史的患者中，25.5%从头发展为CKD。在多变量逻辑回归中，仅纽约心脏协会（NYHA）等级≥III（比值比[OR]：3.9，95％置信区间[CI]：[1.6-9.3]），缺血性心脏病史（IHD）（OR：0.3，95%CI：[0.1-0.7]），和未接受SGLT-2i(OR:0.1,95%CI:[0.02-0.5])是wRF的显著预测因子。
结论：我们的研究表明，在诊断为ATTR-CA后，从头肾功能不全或wRF的发展是常见的。此外,我们发现更差的NYHA等级和之前没有IHD病史是与发展WRF相关的重要预测因子，虽然接受SGLT-2i治疗似乎对该人群具有保护作用。
