Long-term survival in patients with coronary artery disease undergoing percutaneous coronary intervention with or without intracoronary pressure wire guidance: a report from SCAAR

Abstract Background Intracoronary pressure wire measurements of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) provide decision-making guidance during percutaneous coronary intervention (PCI). However, limited data exist on the impact of FFR/iFR on long-term clinical outcomes in patients with stable angina, unstable angina (UA)/non-ST-segment elevation myocardial infarction (NSTEMI), or STEMI. Methods We used data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) on all patients in Sweden undergoing PCI (with or without FFR/iFR guidance) for stable angina, UA/NSTEMI, or STEMI between January 2005 and March 2018. The primary endpoint was all-cause mortality and the secondary endpoints were stent thrombosis or restenosis and periprocedural complications. The primary model was multilevel Cox proportional-hazards regression using an instrumental variable (IV) to adjust for known and unknown confounders with treating hospital as a treatment-preference instrument. The following variables were entered into Cox proportional-hazards regression in addition to the IV: age, sex, diabetes, indication for PCI, severity of coronary disease, smoking status, hypertension, hyperlipidemia, previous myocardial infarction, previous PCI, previous coronary artery bypass graft, type of stent. Results In total, 151,001 patients underwent PCI: 31,514 (20.9%) for stable angina, 74,982 (49.6%) for UA/NSTEMI, and 44,505 (29.5%) for STEMI. Of these, FFR/iFR guidance was used in 11,433 patients (7.6%): 5029 (44.0%) with stable angina, 5989 (52.4%) with UA/NSTEMI, and 415 (3.6%) with STEMI; iFR was used in 1156 (10.1%) of these patients. After a median follow-up of 1784 (range 1–4824) days, the FFR/iFR group had lower adjusted risk estimates for all-cause mortality [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.69–0.91; P=0.001] and stent thrombosis and restenosis (HR 0.13; 95% CI 0.09–0.19; P<0.001). The number of periprocedural complications did not differ significantly between the groups (odds ratio 0.69; 95% CI 0.30–1.55; P=0.368). There was no interaction between FFR/iFR and indication for PCI. We found no difference between FFR and iFR (HR 1.12; 95% CI 0.90–1.59; P=0.216). Conclusions In this observational study, the use of FFR/IFR was associated with a lower risk of long-term mortality in patients undergoing PCI for stable angina, UA/NSTEMI, or STEMI. Our study supports the current European and American guidelines for the use of FFR/iFR during PCI and shows that intracoronary pressure wire guidance has prognostic benefit in patients with stable angina as well as in patients with the acute coronary syndrome. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Heart and Lung Foundation, ALF Västra Götaland, Swedish Scientific Council

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Smokeless tobacco, snus, at admission for percutaneous coronary intervention and future risk for cardiac events

Open Heart ◽

10.1136/openhrt-2019-001109 ◽

2019 ◽

Vol 6 (2) ◽

pp. e001109

Author(s):

Ole Frobert ◽

Christian Reitan ◽

Dorothy K Hatsukami ◽

John Pernow ◽

Elmir Omerovic ◽

...

Keyword(s):

Heart Failure ◽

Percutaneous Coronary Intervention ◽

Smokeless Tobacco ◽

Proportional Hazards ◽

Coronary Intervention ◽

Cox Proportional Hazards ◽

P Value ◽

Cardiac Events ◽

Percutaneous Coronary ◽

All Cause Mortality

ObjectiveTo assess the risk of future death and cardiac events following percutaneous coronary intervention (PCI) in patients using smokeless tobacco, snus, compared with patients not using snus at admission for a first PCI.MethodsThe Swedish Coronary Angiography and Angioplasty Registry is a prospective registry on coronary diagnostic procedures and interventions. A total of 74 958 patients admitted for a first PCI were enrolled between 2009 and 2018, 6790 snus users and 68 168 not using snus. We used Cox proportional hazards regression for statistical modelling on imputed datasets as well as complete-case datasets.ResultsPatients using snus were younger (mean (SD) age 61.0 (±10.2) years) than patients not using snus (67.6 (±11.1), p<0.001) and more often male (95.4% vs 67.4%, p<0.001). After multivariable adjustment, snus use was not associated with the primary composite outcome of all-cause mortality, new coronary revascularisation or new hospitalisation for heart failure at 1 year (HR 0.98, 95% CI 0.91 to 1.05). In patients using snus at baseline who underwent a second PCI (n=1443), the duration from the index intervention was shorter for subjects who continued using snus (n=921, 63.8%) compared with subjects who had stopped (mean number of days 285 vs 406, p value=0.001).ConclusionsSnus use at admission for a first PCI was not associated with a higher occurrence of all-cause mortality, new revascularisation or heart failure hospitalisation. Discontinuing snus after a first PCI was associated with a significantly longer duration to a subsequent PCI.

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Long-term impact of baseline anaemia on clinical outcomes following percutaneous coronary intervention in stable angina

Open Heart ◽

10.1136/openhrt-2020-001319 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001319

Author(s):

Line Davidsen ◽

Kristian Hay Kragholm ◽

Mette Aldahl ◽

Christoffer Polcwiartek ◽

Christian Torp-Pedersen ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Clinical Outcomes ◽

Stable Angina ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

All Cause Mortality ◽

The Impact

BackgroundIn patients with stable angina (SA), the clinical benefits of percutaneous coronary intervention (PCI) reside almost exclusively within the realm of symptomatic improvement rather than improvement in hard clinical endpoints. The benefits of PCI should always be balanced against its potential short-term and long-term risks. Common among these risks is the presence of anaemia and its interaction with poor clinical outcomes and increased morbidity; this study aims to elucidate the impact of anaemia on long-term clinical outcomes of this patient group.MethodsFrom Danish national registries, we identified patients with SA treated with PCI who had a haemoglobin measurement maximum of 90 days prior to PCI procedure. Anaemia was defined as haemoglobin <130 and <120 g/L in men and women, respectively. Follow-up was up to 3 years after PCI, and Cox regression was used to estimate HRs with 95% CIs of hospitalisation due to bleeding, acute coronary syndrome (ACS) and all-cause mortality in patients with anaemia compared with patients without anaemia.ResultsOf 2837 included patients, 14.6% had anaemia prior to PCI. During follow-up, 93 patients (3.3%) had a bleeding episode, which was higher in patients with anaemia (5.8%) compared with patients without anaemia (2.8%). A total of 213 patients (7.5%) developed ACS, which was higher in patients with anaemia (10.6%) compared with patients without anaemia (7.0%). Furthermore, 185 patients (6.5%) died, with a mortality rate of 18.1% in patients with anaemia compared with 4.5% in patients without anaemia. In multivariable analyses, anaemia was associated with a significantly increased risk of bleeding (HR 1.69; 95% CI 1.04 to 2.73; P 0.033), ACS (HR 1.47; 95% CI 1.04 to 2.10; P 0.031) and all-cause mortality (HR 2.41; 95% CI 1.73 to 3.30; P <0.001).ConclusionAnaemia in patients with SA was significantly associated with bleeding, ACS and all-cause mortality following PCI.

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Treatment and Prognosis of Myocardial Infarction Outside Cardiology Departments

Journal of Clinical Medicine ◽

10.3390/jcm10010106 ◽

2020 ◽

Vol 10 (1) ◽

pp. 106

Author(s):

Anton Gard ◽

Bertil Lindahl ◽

Nermin Hadziosmanovic ◽

Tomasz Baron

Keyword(s):

Myocardial Infarction ◽

Coronary Intervention ◽

Cardiology Department ◽

Percutaneous Coronary ◽

All Cause Mortality ◽

Short And Long Term ◽

Long Term Prognosis ◽

One Year

Aim: Our aim was to investigate the characteristics, treatment and prognosis of patients with myocardial infarction (MI) treated outside a cardiology department (CD), compared with MI patients treated at a CD. Methods: A cohort of 1310 patients diagnosed with MI at eight Swedish hospitals in 2011 were included in this observational study. Patients were followed regarding all-cause mortality until 2018. Results: A total of 235 patients, exclusively treated outside CDs, were identified. These patients had more non-cardiac comorbidities, were older (mean age 83.7 vs. 73.1 years) and had less often type 1 MIs (33.2% vs. 74.2%), in comparison with the CD patients. Advanced age and an absence of chest pain were the strongest predictors of non-CD care. Only 3.8% of non-CD patients were investigated with coronary angiography and they were also prescribed secondary preventive pharmacological treatments to a lesser degree, with only 32.3% having statin therapy at discharge. The all-cause mortality was higher in non-CD patients, also after adjustment for baseline parameters, both at 30 days (hazard ratio (HR) 2.28; 95% confidence interval (CI) 1.62–3.22), one year (HR 1.82; 95% CI 1.39–2.36) and five years (HR 1.62; 95% CI 1.32–1.98). Conclusions: MI treatment outside CDs is associated with an adverse short- and long-term prognosis. An improved use of percutaneous coronary intervention (PCI) and secondary preventive pharmacological treatment might improve the long-term prognosis in these patients.

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Percutaneous coronary intervention with everolimus-eluting stents versus coronary artery bypass surgery in patients with stable angina and an isolated proximal left anterior descending artery disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.2535 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I Matsoukis ◽

A Karanasos ◽

C Patsa ◽

N Anousakis-Vlachochristou ◽

K Triantafyllou ◽

...

Keyword(s):

Coronary Artery ◽

Stable Angina ◽

Cardiac Death ◽

Artery Bypass ◽

Composite Index ◽

Coronary Intervention ◽

Target Lesion ◽

Percutaneous Coronary ◽

Secondary Endpoints

Abstract Background/Introduction Revascularization of the proximal segment of left anterior descending artery (pLAD) demonstrates an additional prognostic significance in survival for patients with multivessel disease. It is also indicated for symptomatic relief in patients with stable angina who are receiving optimal medical treatment in the presence of limiting angina or angina equivalent. Both coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are still commonly needed as therapeutic options for pLAD disease. Moreover, Everolimus-eluting stents (EES) have demonstrated superiority in safety and efficacy among other types of second or new generation drug-eluting stents. Purpose We aim to evaluate the long-term outcomes of PCI with EES compared to CABG surgery with left internal mammary artery, in patients with stable angina and an isolated single vessel pLAD disease. Methods The sample consisted of 824 patients with isolated pLAD and chronic stable angina; 445 participants were included in the EES-PCI group, and 379 were included in the CABG group. The study's primary endpoint was the occurrence of major adverse cardiac events (MACEs), namely, cardiac death, myocardial infarction (MI) not attributed to a non-target vessel and target lesion revascularization as a composite index. Secondary endpoints were Patient-Related Outcome (PRO; a composite index of all-cause mortality, any MI related to any coronary artery, any revascularization conducted to any coronary artery), individual components of MACEs, recurrence of stable or unstable angina or a nonfatal arrhythmia and disease progression of other lesions. For the comparisons between the two groups, chi-square tests and Fisher's exact tests, were used, as appropriate. Results During the 4.6 years of follow-up period, no statistically significant difference was observed between the two study groups in respect to the primary endpoint MACE (8.1% versus 7.4%, p=0.71). Concerning secondary endpoints, repeat revascularization (3.6% versus 2.9%, p=0.58), cardiac death (2.9% versus 3.2%, p=0.84), MI (1.6% versus 1.3%, p=0.76) and PRO (16.9% versus 17.7%, p=0.76) did not significantly differ between the two groups. Recurrence of angina was more frequent in the EES-PCI group (14.9% versus 8.4%, p=0.005) even though higher Class of angina was found less common in EES patients than in CABG patients (p<0.001). Patients treated with EES-PCI had lower rates of onset of arrhythmias compared to those treated with CABG (6.3% versus 11.9%, p=0.005). Finally, revascularization in other than target lesion was more frequent in the stent than in the surgery arm (6.3% versus 3.2%, p=0.04); as a consequence, higher rates of revascularization in any vessel was recorded in the PCI group than the CABG one (9.9% versus 5.8%, p=0.03). Conclusion PCI with EES seem to have similar long-term clinical outcomes compared with CABG in patients with isolated pLAD disease. Funding Acknowledgement Type of funding source: None

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Prognostic Impact of Red Cell Distribution Width on the Development of Contrast Induced Nephropathy, Major Adverse Cardiac Events, and Mortality in Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention.

Current Cardiology Reviews ◽

10.2174/1573403x17666210204154812 ◽

2021 ◽

Vol 17 ◽

Author(s):

Azka Latif ◽

Muhammad Junaid Ahsan ◽

Noman Lateef ◽

Vikas Kapoor ◽

Hafiz Muhammad Fazeel ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Intervention ◽

Cardiac Events ◽

Distribution Width ◽

Adverse Cardiac Events ◽

Percutaneous Coronary ◽

All Cause Mortality ◽

Artery Disease

: Red cell distribution width (RDW) serves as an independent predictor towards the prognosis of coronary artery disease (CAD) in patients undergoing percutaneous coronary intervention (PCI). A systematic search of databases such as PubMed, Embase, Web of Science, and Cochrane library was performed on October 10th, 2019 to elaborate the relationship between RDW and in hospital and long term follow up all-cause and cardiovascular mortality, major adverse cardiac events (MACE) and development of contrast-induced nephropathy (CIN) in patients with CAD undergoing PCI. Twenty-one studies qualified this strict selection criteria (number of patients = 56,425): one study was prospective, and the rest were retrospective cohorts. Our analysis showed that patients undergoing PCI with high RDW had a significantly higher risk of in-hospital all-cause mortality (OR 2.41), long-term all-cause mortality (OR 2.44), cardiac mortality (OR 2.65), MACE (OR: 2.16) and odds of developing CIN (OR: 1.42) when compared to the patients with low RDW. Therefore, incorporating RDW in the predictive models for the development of CIN, MACE, and mortality can help in triage to improve the outcomes in coronary artery disease patients who undergo PCI.

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Abstract 15330: Association Between Elective Percutaneous Coronary Intervention Appropriateness and Publicly Reported Outcomes

Circulation ◽

10.1161/circ.142.suppl_3.15330 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Vinay Kini ◽

Paul Hess ◽

Wenhui Liu ◽

Gary Grunwald ◽

Michael Ho ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Proportional Hazards ◽

Coronary Intervention ◽

Cox Proportional Hazards ◽

Veterans Administration ◽

Elective Percutaneous Coronary Intervention ◽

Percutaneous Coronary ◽

National Cohort ◽

Risk Patients ◽

Facility Level

Introduction: Public reporting of percutaneous coronary intervention (PCI) outcomes such as readmission and mortality may cause harm by adversely affecting patient selection for PCI. Little is known about the relationship between these outcomes and elective PCI appropriateness - a validated metric of PCI quality. Methods: We identified all patients in the national Veterans Administration healthcare system who underwent elective PCI for stable coronary disease between 2013 and 2015. We defined PCI appropriateness using 2012 criteria. The primary outcome was 90-day all-cause hospitalization or mortality. We used hierarchical Cox proportional hazards regression models adjusted for patient- and facility-level covariates to compare outcomes across PCI appropriateness categories, and a joint survival/logistic model to compare facility-level variation in inappropriate PCI and 90-day outcomes. Results: Among 2,561 patients (mean age 66 years, 99% men) undergoing PCI across 59 sites, 29.6% were classified as appropriate, 10.4% as inappropriate, and 60% as uncertain. The proportion of patients who were readmitted or died were 15.6%, 16.4%, and 15.3% among patients who received appropriate, inappropriate, and uncertain PCI respectively. There were no significant differences in 90-day outcomes between the groups (hazard ratio for appropriate compared to inappropriate PCI 0.82 [CI 0.57 to 1.17; p=0.28]). The site level covariance between inappropriate PCI and 90-day outcomes was -0.033 (95% CI -0.117 to 0.047), indicating no site-level correlation between appropriateness and 90-day outcomes (Figure). Conclusion: We found no association between elective PCI appropriateness and 90-day outcomes among a national cohort of Veterans. Including appropriateness in public reports may 1) characterize PCI quality more fully and 2) potentially mitigate the harms of reporting outcomes by empowering providers to perform appropriate PCI in higher-risk patients.

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Adjusted Comparison of Outcomes between Patients from CARTITUDE-1 versus Multiple Myeloma Patients with Prior Exposure to PI, Imid and Anti-CD-38 from a German Registry

Cancers ◽

10.3390/cancers13235996 ◽

2021 ◽

Vol 13 (23) ◽

pp. 5996

Author(s):

Maximilian Merz ◽

Hartmut Goldschmidt ◽

Parameswaran Hari ◽

Mounzer Agha ◽

Joris Diels ◽

...

Keyword(s):

Multiple Myeloma ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Average Treatment Effect ◽

T Cell Therapy ◽

Intention To Treat ◽

Proportional Hazards Regression ◽

Overlap Population ◽

German Registry

Ciltacabtagene autoleucel (cilta-cel) is a Chimeric antigen receptor T-cell therapy with the potential for long-term disease control in heavily pre-treated patients with relapsed/refractory multiple myeloma (RRMM). As cilta-cel was assessed in the single-arm CARTITUDE-1 clinical trial, we used an external cohort of patients from the Therapie Monitor registry fulfilling the CARTITUDE-1 inclusion criteria to evaluate the effectiveness of cilta-cel for overall survival (OS) and time to next treatment (TTNT) vs. real-world clinical practice. Individual patient data allowed us to adjust the comparisons between both cohorts, using the inverse probability of treatment weighting (IPW; average treatment effect in the treated population (ATT) and overlap population (ATO) weights) and multivariable Cox proportional hazards regression. Outcomes were compared in intention-to-treat (HR, IPW-ATT: TTNT: 0.13 (95% CI: 0.07, 0.24); OS: 0.14 (95% CI: 0.07, 0.25); IPW-ATO: TTNT: 0.24 (95% CI: 0.12, 0.49); OS: 0.26 (95% CI: 0.13, 0.54)) and modified intention-to-treat (HR, IPW-ATT: TTNT: 0.24 (95% CI: 0.09, 0.67); OS: 0.26 (95% CI: 0.08, 0.84); IPW-ATO: TTNT: 0.26 (95% CI: 0.11, 0.59); OS: 0.31 (95% CI: 0.12, 0.79)) populations. All the comparisons were statistically significant in favor of cilta-cel. These results highlight cilta-cel’s potential as a novel, effective treatment to address unmet needs in patients with RRMM.

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Prognostic value of the ALBI grade among patients with single hepatocellular carcinoma without macrovascular invasion

10.21203/rs.3.rs-30583/v1 ◽

2020 ◽

Author(s):

Heng Zou ◽

Wenhao Chen ◽

Huan Wang ◽

Li Xiong ◽

Yu Wen ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Tumor Size ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Grading System ◽

Term Survival ◽

Proportional Hazards Regression ◽

Disease Outcomes ◽

Single Tumor

Abstract Overview and objective: Although evidence for the application of albumin–bilirubin (ALBI) grading system to assess liver function in hepatocellular carcinoma (HCC) is available, less is known whether it can be applied to determine the prognosis of single HCC with different tumor sizes. This study aimed to address this gap.Methods: Here, we enrolled patients who underwent hepatectomy due to single HCC from the year 2010 to 2014. Analyses were performed to test the potential of ALBI grading system to monitor the long-term survival of single HCC subjects with varying tumor sizes.Results: Overall, 265 participants were recruited. The overall survival (OS) among patients whose tumors were ≤ 7 cm was remarkably higher compared to those whose tumors were > 7 cm. The Cox proportional hazards regression model identified the tumor differentiation grade, ALBI grade, and maximum tumor size as key determinants of the OS. The ALBI grade could stratify the patients who had a single tumor ≤ 7 cm into two distinct groups with different prognoses. The OS between ALBI grades 1 and 2 was comparable for patients who had a single tumor > 7 cm.Conclusions: We show that ALBI grading system can predict disease outcomes of single HCC patients with tumor size ≤ 7 cm. However, the ALBI grade may not predict capability the prognosis of patients with single tumor > 7 cm.

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Prospective Evaluation of the Strategy of Functionally Optimized Coronary Intervention

Journal of the American Heart Association ◽

10.1161/jaha.119.015073 ◽

2020 ◽

Vol 9 (3) ◽

Cited By ~ 1

Author(s):

Barry F. Uretsky ◽

Shiv K Agarwal ◽

Srikanth Vallurupalli ◽

Malek Al‐Hawwas ◽

Rimsha Hasan ◽

...

Keyword(s):

Coronary Intervention ◽

Interquartile Range ◽

Fractional Flow ◽

Long Term Outcomes ◽

Flow Reserve ◽

Pressure Wire ◽

Percutaneous Coronary ◽

Before And After ◽

The Impact

Background Long‐term outcomes after percutaneous coronary intervention (PCI) relate in part to residual ischemia in the treated vessel, as reflected by post‐PCI fractional flow reserve (FFR). The strategy of FFR after PCI and treatment of residual ischemia—known as functionally optimized coronary intervention (FCI)—may be feasible and capable of improving outcomes. Methods and Results Feasibility and results of FCI using an optical‐sensor pressure wire were prospectively evaluated in an all‐comer population with 50% to 99% lesions and ischemic FFR (≤0.80; ClinicalTrials.gov identifier NCT03227588). FCI was attempted in 250 vessels in 226 consecutive patients. The PCI success rate was 99.6% (249/250 vessels). FCI technical success—that is, FFR before and after PCI and PCI itself using the FFR wire—was 92% (230/250 vessels). Incidence of residual ischemia in the treated vessel was 36.5%. Approximately a third of these vessels (34.5%, n=29) were considered appropriate for further intervention, with FFR increasing from 0.71±0.07 to 0.81±0.06 ( P <0.001). Pressure wire pullback showed FFR ≤0.8 at distal stent edge was 7.9% and 0.7% proximal to the stent. FFR increase across the stent was larger in the ischemic than in the nonischemic group (0.06 [interquartile range: 0.04–0.08] versus 0.03 [interquartile range: 0.01–0.05]; P <0.0001) compatible with stent underexpansion as a contributor to residual ischemia. Conclusions FCI is a feasible and safe clinical strategy that identifies residual ischemia in a large proportion of patients undergoing angiographically successful PCI. Further intervention can improve ischemia. The impact of this strategy on long‐term outcomes needs further study.

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Kidney Clearance of Secretory Solutes Is Associated with Progression of CKD: The CRIC Study

Journal of the American Society of Nephrology ◽

10.1681/asn.2019080811 ◽

2020 ◽

Vol 31 (4) ◽

pp. 817-827 ◽

Cited By ~ 8

Author(s):

Yan Chen ◽

Leila R. Zelnick ◽

Ke Wang ◽

Andrew N. Hoofnagle ◽

Jessica O. Becker ◽

...

Keyword(s):

Kynurenic Acid ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Ckd Progression ◽

Glomerular Function ◽

Additional Information ◽

Proportional Hazards Regression ◽

All Cause Mortality ◽

Liquid Chromatography Tandem Mass ◽

Urine Concentrations

BackgroundThe secretion of organic solutes by the proximal tubules is an essential intrinsic kidney function. However, the clinical significance of the kidney’s clearance of tubular secretory solutes is uncertain.MethodsIn this prospective cohort study, we evaluated 3416 participants with CKD from the Chronic Renal Insufficiency Cohort (CRIC) study. We measured plasma and 24-hour urine concentrations of endogenous candidate secretory solutes at baseline, using targeted liquid chromatography–tandem mass spectrometry. The study defined CKD progression by a ≥50% decline in the eGFR, initiation of maintenance dialysis, or kidney transplantation. We used Cox proportional hazards regression to test associations of secretory-solute clearances with CKD progression and mortality, adjusting for eGFR, albuminuria, and other confounding characteristics.ResultsParticipants in this ancillary study had a mean age of 58 years and 41% were black; the median eGFR was 43 ml/min per 1.73 m2. After adjustment, lower kidney clearances of six solutes—kynurenic acid, pyridoxic acid, indoxyl sulfate, xanthosine, isovalerylglycine, and cinnamoylglycine—were associated with significantly greater risks of CKD progression, with clearance of kynurenic acid, a highly protein-bound solute, having the strongest association. Lower clearances of isovalerylglycine, tiglylglycine, hippurate, and trimethyluric acid were significantly associated with all-cause mortality after adjustment.ConclusionsWe found lower kidney clearances of endogenous secretory solutes to be associated with CKD progression and all-cause mortality, independent of eGFR and albuminuria. This suggests that tubular clearance of secretory solutes provides additional information about kidney health beyond measurements of glomerular function alone.

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