Is Renal Impairment an Anticipated COPD Comorbidity?

Aims Chronic obstructive pulmonary disease (COPD) is an important comorbidity in heart failure (HF) with reduced ejection fraction (HFrEF), associated with worse outcomes and often suboptimal treatment because of under‐prescription of beta‐blockers. Consequently, additional effective therapies are especially relevant in patients with COPD. The aim of this study was to examine outcomes related to COPD in a post hoc analysis of the Dapagliflozin And Prevention of Adverse‐outcomes in Heart Failure (DAPA‐HF) trial. Methods and results We examined whether the effects of dapagliflozin in DAPA‐HF were modified by COPD status. The primary outcome was the composite of an episode of worsening HF or cardiovascular death. Overall, 585 (12.3%) of the 4744 patients randomized had a history of COPD. Patients with COPD were more likely to be older men with a history of smoking, worse renal function, and higher baseline N‐terminal pro B‐type natriuretic peptide, and less likely to be treated with a beta‐blocker or mineralocorticoid receptor antagonist. The incidence of the primary outcome was higher in patients with COPD than in those without [18.9 (95% confidence interval 16.0–22.2) vs. 13.0 (12.1–14.0) per 100 person‐years; hazard ratio (HR) for COPD vs. no COPD 1.44 (1.21–1.72); P < 0.001]. The effect of dapagliflozin, compared with placebo, on the primary outcome, was consistent in patients with [HR 0.67 (95% confidence interval 0.48–0.93)] and without COPD [0.76 (0.65–0.87); interaction P‐value 0.47]. Conclusions In DAPA‐HF, one in eight patients with HFrEF had concomitant COPD. Participants with COPD had a higher risk of the primary outcome. The benefit of dapagliflozin on all pre‐specified outcomes was consistent in patients with and without COPD. Clinical Trial Registration: ClinicalTrials.gov ID NCT03036124.

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“…A likely explanation is the higher prevalence of renal dysfunction among patients with COPD, compared to those without COPD. 27 . .…”

Section: Discussionmentioning

confidence: 99%

“…More surprisingly, however, was the finding that MRA use was also significantly less common in patients with COPD, despite their worse functional class. A likely explanation is the higher prevalence of renal dysfunction among patients with COPD, compared to those without COPD 27 …”

Section: Discussionmentioning

confidence: 99%

Effects of dapagliflozin in heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: an analysis of DAPA‐HF

Dewan

Docherty

Bengtsson

et al. 2021

European J of Heart Fail

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“…The subgroup analysis of COPD subjects showed a similar result, while both the two analyses did not reveal an association between spirometry data and concealed CRF reported by AbdelHalim and AboElNaga. 33 We further investigated the predictive value of ADAMTS-13 on predicting concealed CRF in COPD patients using ROC curves, and the results showed that it possessed rather a high diagnostic value ( Figure 1 ).…”

Section: Discussionmentioning

confidence: 99%

Predictive value of ADAMTS-13 on concealed chronic renal failure in COPD patients

Zeng

Chen

Liang

et al. 2017

COPD

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BackgroundImpaired renal function is often neglected in COPD patients. Considering that COPD patients usually have an ongoing prothrombotic state and systemic inflammation status, we investigated the association among them and explored the predictive value of a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS-13), on concealed chronic renal failure (CRF) in COPD patients.MethodsCOPD patients were recruited from the First Affiliated Hospital of Sun Yat-Sen University between January 2015 and December 2016. Control was selected from contemporaneous hospitalized patients without COPD and matched by age and gender at a ratio of 1:1. Estimated glomerular filtration rate (eGFR) was calculated by using the Chronic Kidney Disease Epidemiology Collaboration formula, and all subjects were categorized as having normal renal function (eGFR ≥60 mL min−1 1.73 m−2) and having concealed CRF (normal serum creatinine while eGFR <60 mL min−1 1.73 m−2). Independent correlates of concealed CRF were investigated by logistic regression analysis, and receiver operating characteristic (ROC) curves were used to determine the predictive value of ADAMTS-13.ResultsIn total, 106 COPD and 106 non-COPD patients were finally recruited, and the incidences of concealed CRF were 19.81% and 7.55%, respectively. ADAMTS-13 (odds ratio [OR] =0.858, 95% CI =0.795–0.926), D-dimer (OR =1.095, 95% CI =1.027–1.169), and C-reactive protein (OR =1.252, 95% CI =1.058–1.480) were significantly associated with concealed CRF. Sensitivity and specificity at an ADAMTS-13 cutoff of 318.72 ng/mL were 100% and 81.2%, respectively. The area under the ROC curve was 0.959.ConclusionProthrombotic state and systemic inflammation status might contribute to explaining the high incidence of concealed CRF in COPD, and plasma ADAMTS-13 levels may serve as a strong predictor.

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“…A study from Egypt by Abdelhalim and AboElNaga involving 136 COPD patients and 104 control subjects provided slightly different results [ 13 ]. The percentage for concealed and overt CRF in COPD patients was 19.85% and 6.62%, respectively, whereas in the control group, it was 1.92% and 0%, respectively.…”

Section: Reviewmentioning

confidence: 99%

“…The percentage for concealed and overt CRF in COPD patients was 19.85% and 6.62%, respectively, whereas in the control group, it was 1.92% and 0%, respectively. The study found a greater prevalence of CRF in patients with a more advanced stage of COPD (Global Initiative for Chronic Obstructive Lung Disease, or GOLD, stages C and D) [ 13 ]. Another study by Elmahallawy and Qora involving 600 patients (300 COPD and 300 control) found a higher prevalence of CRF [ 14 ].…”

Section: Reviewmentioning

confidence: 99%

Is There an Association Between Chronic Obstructive Pulmonary Disease and Chronic Renal Failure?

Madouros¹,

Jarvis²,

Saleem³

et al. 2022

Cureus

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Chronic obstructive pulmonary disease (COPD) is one of the most common diseases worldwide with its prevalence increasing with age. It is commonly comorbid with other diseases and managing patients could be difficult and expensive. Chronic kidney disease (CKD) is often present in COPD patients and may be underdiagnosed, especially if it is mild. This study intended to summarize recent findings showing the correlation between the two diseases. Studies were gathered that were published in the last 11 years, from 2010 to 2021. PubMed was used as the main source of data, but papers from the references of the included other sources were added for thoroughness. Observational studies on examining the prevalence and prognosis of comorbid COPD and CKD published in the English language were included. A higher prevalence of CKD in COPD patients was found in most studies; it was found that a higher risk of mortality is present if these diseases coexist. Further research is required and more extensive prospective studies are needed with matched control groups to support the correlation.

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Is Renal Impairment an Anticipated COPD Comorbidity?

Cited by 15 publications

References 26 publications

Effects of dapagliflozin in heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: an analysis of DAPA‐HF

Effects of dapagliflozin in heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: an analysis of DAPA‐HF

Predictive value of ADAMTS-13 on concealed chronic renal failure in COPD patients

Is There an Association Between Chronic Obstructive Pulmonary Disease and Chronic Renal Failure?

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