Association of Osteopontin and selective glomerular hypofiltration syndrome with hospitalization for kidney failure in acute heart failure patients.

BACKGROUND

Selective glomerular hypofiltration syndrome (SGHS), formerly shrunken pore syndrome, an emerging marker of glomerular dysfunction, is associated with worsened prognosis in cardiovascular disease, but its role in kidney failure remains underexplored. Osteopontin (OPN) is associated with worsening kidney function and prognosis in chronic kidney disease.

PURPOSE: To explore if increased levels of OPN and SGHS are associated with hospitalization for kidney failure in patients with acute heart failure (HF).

METHODS

OPN was analyzed in 315 hospitalized HF patients using a proximity extension assay. SGHS was defined as cystatin C-based estimated GFR (eGFR) < 60% of the creatinine-based eGFR. Clinical outcomes were retrieved from regional registries (ICD-10 N17-N19). Multivariable logistic and Cox regression models adjusted for known risk factors were used for associations between OPN and SGHS and their association with hospitalization for kidney failure.

RESULTS

The mean age was 74 years, 33% were female and 15% presented with SGHS. Patients with SGHS had higher BMI, OPN- and cystatin C levels and higher mean eGFR. During the median follow-up period of 28 months, 46 patients were hospitalized for kidney failure. Increased OPN-levels were associated with prevalent SGHS (odds ratio 2.50, p < 0.001), and higher risk of hospitalization for acute kidney failure (hazard ratio (HR) 4.66, p < 0.001) as did prevalent SGHS (HR 4.82, p < 0.001).

CONCLUSIONS

In HF patients, OPN was associated with a higher prevalence of SGHS and both OPN and SGHS were associated with higher risk of hospitalization for kidney failure. Our results suggest that OPN and SGHS can identify HF patients at high risk of kidney function decline.