Effect of Severity and Etiology of Chronic Kidney Disease in Patients with Heart Failure with Mildly Reduced Ejection Fraction

Overview

Journal Clin Res Cardiol

Specialty Cardiology & Vascular Diseases

Date 2024 May 6

PMID 38709336

Authors

Tobias Schupp

Kathrin Weidner

Felix Lau

Jan Forner

Alexander Schmitt

Marielen Reinhardt

Noah Abel

Niklas Ayasse

Thomas Bertsch

Muharrem Akin

Christel Weiss

Ibrahim Akin

Michael Behnes

Affiliations

Soon will be listed here.

Abstract

Objective: The study investigates the prognostic impact of the severity and etiology of chronic kidney disease (CKD) in patients with heart failure with mildly reduced ejection fraction (HFmrEF).

Background: Data regarding the outcomes in patients with CKD in HFmrEF is scarce.

Methods: Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. Prognosis of patients with different stages and etiologies of CKD was investigated with regard to the primary endpoint of all-cause mortality at 30 months.

Results: A total of 2155 consecutive patients with HFmrEF were included with an overall prevalence of CKD of 31%. Even milder stages of CKD (i.e., KDIGO stage 3a) were associated with an increased risk of 30-months all-cause mortality (HR = 1.242; 95% CI 1.147-1.346; p = 0.001). However, long-term prognosis did not differ in patients with KDIGO stage 5 compared to patients with stage 4 (HR = 0.886; 95% CI 0.616-1.275; p = 0.515). Furthermore, the highest risk of HF-related rehospitalization was observed in patients with KDIGO stages 3b and 4 (log rank p ≤ 0.015), whereas patients with KDIGO stage 5 had a lower risk of HF-related rehospitalization compared to patients with KDIGO stage 4 (HR = 0.440; 95% CI 0.228-0.849; p = 0.014). In contrast, the etiology of CKD was not associated with the risk of 30-month all-cause mortality (log rank p ≥ 0.347) and HF-related rehospitalization (log rank p ≥ 0.149).

Conclusion: In patients with HFmrEF, even milder stages of CKD were independently associated with increased risk of 30-months all-cause mortality.

References

McDonagh T, Metra M, Adamo M, Gardner R, Baumbach A, Bohm M . Corrigendum to: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With.... Eur Heart J. 2021; 42(48):4901. DOI: 10.1093/eurheartj/ehab670. View

Butler J, Packer M, Siddiqi T, Bohm M, Brueckmann M, Januzzi J . Efficacy of Empagliflozin in Patients With Heart Failure Across Kidney Risk Categories. J Am Coll Cardiol. 2023; 81(19):1902-1914. DOI: 10.1016/j.jacc.2023.03.390. View

Yandrapalli S, Christy J, Malik A, Wats K, Harikrishnan P, Aronow W . Impact of Acute and Chronic Kidney Disease on Heart Failure Hospitalizations After Acute Myocardial Infarction. Am J Cardiol. 2021; 165:1-11. DOI: 10.1016/j.amjcard.2021.10.041. View

Patel R, Fonarow G, Greene S, Zhang S, Alhanti B, DeVore A . Kidney Function and Outcomes in Patients Hospitalized With Heart Failure. J Am Coll Cardiol. 2021; 78(4):330-343. PMC: 8994871. DOI: 10.1016/j.jacc.2021.05.002. View

Escobar C, Palacios B, Varela L, Gutierrez M, Duong M, Chen H . Prevalence, Characteristics, Management and Outcomes of Patients with Heart Failure with Preserved, Mildly Reduced, and Reduced Ejection Fraction in Spain. J Clin Med. 2022; 11(17). PMC: 9456780. DOI: 10.3390/jcm11175199. View

Levey A, Stevens L . Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis. 2010; 55(4):622-7. PMC: 2846308. DOI: 10.1053/j.ajkd.2010.02.337. View

Carrero J, Fu E, Vestergaard S, Jensen S, Gasparini A, Mahalingasivam V . Defining measures of kidney function in observational studies using routine health care data: methodological and reporting considerations. Kidney Int. 2022; 103(1):53-69. DOI: 10.1016/j.kint.2022.09.020. View

Schmitt A, Schupp T, Reinhardt M, Abel N, Lau F, Forner J . Prognostic impact of acute decompensated heart failure in patients with heart failure with mildly reduced ejection fraction. Eur Heart J Acute Cardiovasc Care. 2023; 13(2):225-241. DOI: 10.1093/ehjacc/zuad139. View

Lofman I, Szummer K, Dahlstrom U, Jernberg T, Lund L . Associations with and prognostic impact of chronic kidney disease in heart failure with preserved, mid-range, and reduced ejection fraction. Eur J Heart Fail. 2017; 19(12):1606-1614. DOI: 10.1002/ejhf.821. View

10.

Costanzo M, Negoianu D, Jaski B, Bart B, Heywood J, Anand I . Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure. JACC Heart Fail. 2015; 4(2):95-105. DOI: 10.1016/j.jchf.2015.08.005. View

11.

Kober L, Torp-Pedersen C, Carlsen J, BAGGER H, Eliasen P, LYNGBORG K . A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. N Engl J Med. 1995; 333(25):1670-6. DOI: 10.1056/NEJM199512213332503. View

12.

Popescu B, Andrade M, Badano L, Fox K, Flachskampf F, Lancellotti P . European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography. Eur J Echocardiogr. 2009; 10(8):893-905. DOI: 10.1093/ejechocard/jep151. View

13.

Matsushita K, van der Velde M, Astor B, Woodward M, Levey A, de Jong P . Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010; 375(9731):2073-81. PMC: 3993088. DOI: 10.1016/S0140-6736(10)60674-5. View

14.

Chen S, Huang Z, Liang Y, Zhao X, Aobuliksimu X, Wang B . Five-year mortality of heart failure with preserved, mildly reduced, and reduced ejection fraction in a 4880 Chinese cohort. ESC Heart Fail. 2022; 9(4):2336-2347. PMC: 9288761. DOI: 10.1002/ehf2.13921. View

15.

Marenzi G, Muratori M, Cosentino E, Rinaldi E, Donghi V, Milazzo V . Continuous ultrafiltration for congestive heart failure: the CUORE trial. J Card Fail. 2013; 20(1):9-17. DOI: 10.1016/j.cardfail.2013.11.004. View

16.

Bardy G, Lee K, Mark D, Poole J, Packer D, Boineau R . Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005; 352(3):225-37. DOI: 10.1056/NEJMoa043399. View

17.

Butler J, Usman M, Filippatos G, Ferreira J, Bohm M, Brueckmann M . Safety and Efficacy of Empagliflozin and Diuretic Use in Patients with Heart Failure and Preserved Ejection Fraction: A Post Hoc Analysis of the EMPEROR-Preserved Trial. JAMA Cardiol. 2023; 8(7):640-649. PMC: 10209829. DOI: 10.1001/jamacardio.2023.1090. View

18.

Lopez-Ponce de Leon J, Gomez-Mesa J, Saldarriaga C, Echeverria L, Posada-Bastidas A, Garcia J . Prevalence, Clinical Characteristics, and Prognostic Impact of Kidney Disease on Heart Failure Patients: An Observational Study of the Colombian Heart Failure Registry. Cardiorenal Med. 2023; 13(1):292-300. DOI: 10.1159/000530852. View

19.

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

20.

Chioncel O, Lainscak M, Seferovic P, Anker S, Crespo-Leiro M, Harjola V . Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017; 19(12):1574-1585. DOI: 10.1002/ejhf.813. View