Background: Determining the prognosis of heart failure with preserved ejection fraction (HFpEF) is problematic, as the ejection fraction cannot be used. Formulae that estimate glomerular filtration rate (eGFR) may be potential prognosticators for this condition, since renal dysfunction is a well-known predictor of poor outcomes of all forms of heart failure. Methods: A prospective observational study of 117 HFpEF patients (average age 71.6±9.1 years; 65.8% women) who had eGFR determined after their first episode of cardiac decompensation by two different chronic kidney disease epidemiology collaboration (CKD-EPI) equations. The ability to predict hospitalizations and mortality over 24 months by the two equations were compared. Results: The CKD-EPI formula based on serum creatinine only performed poorly. However, the CKD-EPI equation that used both serum creatinine and serum cystatin C was associated with unfavorable outcome: eGFR <45 mL/min/1.73 m 2 predicted 24-month mortality (HR=4.21 [1.32;13.43], p =0.02) and the combined endpoint of mortality and hospitalization (HR 2.45 [1.42;4.22], p =0.001). . Conclusions: eGFR by the CKD-EPI equation based on serum creatinine and cystatin C levels, but not by the CKD-EPI creatinine only equation, predicts the outcome of HFpEF patients.

Objective. To estimate the prevalence of chronic kidney disease (CKD) 3b – 5 stages and the newly diagnosed sustained reduction in glomerular filtration rate (GFR) <30 ml / min / 1.73 m2 in patients with atrial fibrillation (AF) in real clinical practice, as well as the features of their anticoagulant therapy.Materials and Methods. Retrospectively, data of all discharge epicrisis from cardiological departments of five Moscow hospitals from June 1, 2016 to May 31, 2017 were analyzed. Patients over 18 years old with AF were enrolled. At the next stage, patients with CKD 3 b – 5 st and newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 (at least 2 measurements during hospitalization) were selected.Results. Data of 9725 patients were analyzed, AF was diagnosed in 2983 (31 %) cases, of which a decreased GFR <45 ml / min / 1.73 m2 was detected in 27 % (n = 794) cases. Among them, 349 (44 %) were diagnosed with CKD 3b st, 123 (15 %) with CKD 4 st, 44 (6 %) with CKD 5 st, 278 (35 %) had a newly diagnosed sustained reduction in GFR. In 63 % of patients with AF and GFR <45 ml / min / 1.73 m2, anemia was diagnosed, 39 % of them had moderate and severe one. 711 (89 %) patients were prescribed anticoagulants, 53 % were assigned direct oral anticoagulants (DOACs). Patients with CKD 3 b st. more often rivaroxaban 15 mg (29 %) was prescribed, with CKD 4 and CKD 5 – warfarin (48 % and 25 %, respectively), in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2 – apixaban 10 mg / day (16.2 %).Conclusion. A quarter of patients with AF revealed a decreased GFR <45 ml / min / 1.73 m2, half of them were recommended DOACs. 42 % of patients with GFR <30 ml / min / 1.72 m2 were prescribed DOACs, 27 % – warfarin. Patients with CKD 5 st DOACs were not assigned; in half of cases, none of the anticoagulants was recommended. Most often, the dose of the prescribed anticoagulant was not counted according to GFR in patients with newly diagnosed sustained reduction in GFR <30 ml / min / 1.73 m2.

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Background Atrial fibrillation (AF) is a common comorbidity in around 10–15% of patients (pts) with CKD, while 30% of those with AF have CKD. In pts with advanced stages of CKD, safety and efficacy profiles of novel oral anticoagulants, in particular rivaroxaban, have been understudied. Purpose To evaluate safety and efficacy of rivaroxaban in pts with stage 4 CKD or a transient reduction in glomerular filtration rate (GFR) to 15–29 ml/min/1.73 m2. Materials and methods Data of 3,500 pts with nonvalvular AF in cardiovascular units for the period from 2017 to 2019 were analyzed. Of these, 507 (15%) showed a decrease in GFR to 29–15 ml/min/1.73 m2. 109 (3.1%) pts enrolled in the study (in accordance with inclusion criteria) and were randomized in a 2: 1 fashion to either the 15 mg rivaroxaban (n=74) or warfarin (n=36) group. The pts had either not previously been taking anticoagulants, or TTR was &lt;65% in the case of taking warfarin. The average follow-up period was 18 months. Visits took place every 3 months, when compliance, haemoglobin were checked and GFR calculation was carried out. Primary endpoint: development of major and minor bleeding on the BARC scale. Secondary endpoints: thromboembolic events, cardiovascular mortality and all-cause mortality. Results The pts were of similar clinical and demographic profile. The median age was 77 years with 32 men in the rivaroxaban group and 14 in the warfarin group. The average CHA2DS2-VASc score was 4.6 and 4.7 (n/s) in the rivaroxaban and warfarin group, respectively, while the average HAS-BLED score was 3 (n/s) in both. Pts taking warfarin were significantly more likely to develop minor bleedings: 26 (72%) vs 27 (37%) in the rivaroxaban group, p=0.001. There were not detected significant differences in the ratio of major bleedings (warfarin 3 (8.3%) versus rivaroxaban 2 (2.7%) cases, p=0.3). No significant differences at secondary endpoints were observed. In the warfarin group, 1 (2.8%) ischemic stroke and 1 fatal haemorrhagic stroke occurred. In the rivaroxaban group, 1 (1.4%) ischemic stroke occurred during a 5-day break in taking the anticoagulant. 5 (6.9%) pts in the rivaroxaban group developed ACS, vs 1 (2.8%) in the warfarin group (n/s). 2 (2.7%) pts died from myocardial infarction in the rivaroxaban group and 1 (2.8%) - in the warfarin group (n/s). Mortality from all causes was 5 (6.6%) in the rivaroxaban group and 3 (8.3%) in the warfarin group (n/s). In the rivaroxaban group, GFR (CG formula) improved significantly more since the 3rd month of observation (in the 18th month of observation, the median value was 35.0 [29.0; 39.5] ml/min/1.73 m2 vs 27.0 [21.5; 31.5] ml/min/1.73 m2 in the warfarin group, p&lt;0.001). Conclusion Significantly more pts within the warfarin group had minor bleedings. Pts during warfarin and rivaroxaban therapy showed an improvement in glomerular filtration, which was more pronounced in the rivaroxaban group. Funding Acknowledgement Type of funding source: None