Marianna Fontana, MD, PhD: Declines in Kidney Function Frequent in ATTR-CM

A decline in kidney function was common in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) and linked to an elevated likelihood of mortality, even after adjustment for relevant biomarkers, according to new data presented at the American Heart Association (AHA) Scientific Sessions 2024.

This retrospective, observational, single-center cohort study assesed individuals with ATTR-CM at the National Amyloidosis Centre (NAC) in the United Kingdom, who underwent an assessment of baseline estimated glomerular filtration rate (eGFR) and 1-year follow-up between January 2000 and April 2024.

“We took a large population of patients, more than 2000 patients, with a ATTR-CM, and we did a landmark analysis at 12 months, where we measured the eGFR. We found, at 12 months, a change of 20% decline, an independently predictive prognosis,” Marianna Fontana, MD, PhD, a professor of cardiology and honorary consultant cardiologist at the National Amyloidosis Centre, division of medicine, University College London, told HCPLive.

The study’s primary outcome was the risk of all-cause mortality associated with a decline in kidney function, considered a decrease in eGFR of >20%.

Upon analysis, the decline in kidney function was associated with a 1.7-fold higher risk of mortality (hazard ratio [HR], 1.71; 95% CI, 1.43-2.04; P < .001), with a similar risk across all 3 genotypes (wild type: HR, 1.64; 95% CI, 1.31-2.04; p.(V142I): HR, 1.70; 95% CI, 1.21-2.39; non-p.(V142I): HR, 1.51; 95% CI, 0.87-2.61) (P for interaction = .93) and the 3 NAC disease stages (stage 1: HR, 1.69; 95% CI, 1.22-2.32; stage 2: HR, 1.69; 95% CI, 1.30-2.18; stage 3: HR, 1.61; 95% CI, 1.11-2.35) (P for interaction = .97).

Importantly, the decline in kidney function was consistently, independently associated with mortality, after adjustment for increases in NT-proBNP and outpatient diuretic intensification (HR, 1.48; 95% CI, 1.23-2.76; P < .001).

“This is just the first step, one of the things that will need to be assessed is, for example, using this treatment to guide treatment response and [determine if] it improves management of the patients,” Fontana told HCPLive.

Disclosures: Relevant disclosures for Fontana include Alnylam Pharmaceuticals, Bayer, Intellia Therapuetics, Janssen Pharmaceuticals, Novo Nordisk, and others.

References

Ioannou A, Razvi Y, Porcari A, et al. Kidney Outcomes in Transthyretin Amyloid Cardiomyopathy. JAMA Cardiol. Published online November 17, 2024. doi:10.1001/jamacardio.2024.4578