Rapid Progression of Chronic Kidney Disease Prior to the Diagnosis of Wild-Type Transthyretin Cardiac Amyloidosis
Background: Wild-type transthyretin amyloidosis cardiac amyloidosis (wtATTR-CA) is a progressive, fatal heart condition characterized by misfolded TTR proteins into amyloid fibrils. Chronic Kidney disease (CKD) is prevalent in patients with wtATTR-CA and has shown to predict poor outcomes in wtATTR-CA. However, its prevalence and rate of decline prior to diagnosis is less clear especially when considering common comorbidities (hypertension [HTN], heart failure [HF], Type II Diabetes [DM]).
Materials/Methods: Retrospective analysis was conducted on a sample of 188 wtATTR-CA (2009-2025; median age 80; 93% male) diagnosed patients. Clinical CKD diagnosis and stage progression along with the common comorbidities (HF, DM, HTN) were assessed from five years prior to time of wtATTR-CA diagnosis.
Results: CKD prevalence rose consistently from five years prior until wtATTR-CA diagnosis. Five years prior to diagnosis 14% had CKD, three years prior 18% had CKD, one year prior 33% had CKD, and 40% at time of wtATTR-CA diagnosis. Stage 3A and Stage 3B were the most common forms of CKD across all timepoints. Heart failure (13%, 19%, 47%, and 68%, respectively) and hypertension (59%, 69%, 73%, and 75%, respectively) also rose across all timepoints while the rate of diabetes was relatively constant (22%, 23%, 26%, and 26%, respectively)
Conclusion: The likelihood of CKD, HF, and HTN are increasing in our cohort as one gets closer to the time of diagnosis. In our cohort, CKD decline seems to precede the diagnosis of wtATTR-CA prompting whether patients with rapidly declining CKD of unknown etiology should be screened for heart disease and particularly ATTR.