Prioritize Sustained decongestion over preserving kidney function in modest eGFR decline: Study

The association of these groups with all-cause mortality was assessed using marginal structural models to account for time-dependent confounding. Results: The mean (SD) age and eGFR at discharge were 66 (12) years and 59.6 (22.3) mL/min/1.73 m2, respectively. Over a median (IQR) follow-up of 44 (25–71) weeks, 740 patients died. Both higher degrees of eGFR decline and worsened congestion were associated with higher mortality risk. Compared to patients with worsened congestion and no eGFR decline, those with improved congestion had lower mortality risk (HR, 0.51 [95% CI, 0.35–0.74] for no eGFR decline; HR, 0.56 [95% CI, 0.38–0.85] for 1–20% eGFR decline; and HR, 0.80 [95% CI, 0.46–1.39] for 21–40% eGFR decline), while those with improved congestion and 41% or greater eGFR decline had higher risk (HR, 2.23; 95% CI, 1.06–4.66).

Compared to worsened congestion and no GFR decline, improved congestion is generally associated with lower mortality risk but higher risk when eGFR decline exceeds 40%, suggesting the importance of sustaining decongestion over preserving kidney function if eGFR decline is modest.

Reference:

Oka, Tatsufumi1,2; Tighiouart, Hocine3,4; McCallum, Wendy1; Tuttle, Marcelle1; Isaka, Yoshitaka2; Konstam, Marvin A.5; Udelson, James E.5; Sarnak, Mark J.1,a. Thresholds of Kidney Function Decline and Congestion Status and Their Relation with Outcomes Among Discharged Heart Failure Patients. Clinical Journal of the American Society of Nephrology ():10.2215/CJN.0000000768, July 11, 2025. | DOI: 10.2215/CJN.0000000768