Chronic Kidney Disease and Outcomes in Heart Failure With Preserved Versus Reduced Ejection Fraction

Abstract

Background There is scant evidence on the effect that chronic kidney disease (CKD) confers on clinically meaningful outcomes among patients with heart failure with preserved left ventricular ejection fraction (HF-PEF). Methods and Results We identified a community-based cohort of patients with HF. Electronic medical record data were used to divide into HF-PEF and reduced left ventricular EF on the basis of quantitative and qualitative estimates. Level of CKD was assessed by estimated glomerular filtration rate (eGFR) and by dipstick proteinuria. We followed patients for a median of 22.1 months for outcomes of death and hospitalization (HF-specific and all-cause). Multivariable Cox regression estimated the adjusted relative-risk of outcomes by level of CKD, separately for HF-PEF and HF with reduced left ventricular EF. We identified 14 579 patients with HF-PEF and 9762 with HF with reduced left ventricular EF. When compared with patients with eGFR between 60 and 89 mL/min per 1.73 m2, lower eGFR was associated with an independent graded increased risk of death and hospitalization. For example, among patients with HF-PEF, the risk of death was nearly double for eGFR 15 to 29 mL/min per 1.73 m2 and 7× higher for eGFR<15 mL/min per 1.73 m2, with similar findings in those with HF with reduced left ventricular EF. Conclusions CKD is common and an important independent predictor of death and hospitalization in adults with HF across the spectrum of left ventricular systolic function. Our study highlights the need to develop new and effective interventions for the growing number of patients with HF complicated by CKD.

Heart failure with multiple comorbidities

“…Renal insufficiency was associated with a 25-30% increase in mortality [16]. Worsening glomerular filtration rate was associated with a graded increase in the risk for death and hospitalization, with similar findings in those with HFpEF and HFrEF [58]. Despite concerns related to hyperkalemia, therapies such as ACE inhibitors should still be initiated in accordance with current guidelines [59].…”

Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting Adverse Events in Elderly Patients With Chronic Heart Failure

“…Furthermore, physiological relations between CKD and heart failure are multifactorial and causally intertwined. 26) Thus, a higher N/L ratio was associated with an increased risk of CKD which may make the prognosis of heart failure worse in the elderly with CHF. Association between the N/L ratio and heart failure: Several studies have found an association of the N/L ratio with heart failure, especially in acute heart failure.…”

Impact of Chronic Kidney Disease on Myocardial Blood Flow Regulation in Dogs

“…The physiological relations between chronic kidney disease (CKD) and cardiovascular disease leading to cardiac dysfunction are multifactorial and causally interconnected; CKD contributes to heart failure by increasing salt retention and volume expansion and upregulating neurohormonal pathways as well as proinflammatory and other mechanisms [1]. On the other hand, heart failure worsens CKD by decreasing renal perfusion and activating the catecholaminergic and renin-angiotensin-aldosterone systems.…”