There are no studies of long-term worsening renal function (WRF) in heart failure
(HF) with different ejection fraction (EF) groups. The aim was to compare incidence
of, associations with and prognostic impact of WRF in HF with preserved (HFpEF), mid-range
(HFmrEF), and reduced EF (HFrEF). The Swedish Heart Failure Registry (SwedeHF) was
merged with the Stockholm Creatinine Measurement (SCREAM) registry 2006 to 2010. The
associations between EF and WRF (≥25% decrease in eGFR) and the associations between
WRF25-49% and WRF≥50% within year one and subsequent all-cause mortality were all
assessed with multiadjusted Cox regression. Of 7,154 patients, 41.6% of HFpEF versus
34.5% and 35.4% of HFmrEF and HFrEF patients developed WRF≥25% during year one. The
WRF risk was higher in HFpEF (reference) than in HFmrEF, hazard ratio (95% confidence
interval) 0.890 (0.794 to 0.997) and HFrEF 0.870 (0.784 to 0.965). WRF within year
one was strongly associated with subsequent long-term mortality in all EF groups,
yielding adjusted HRs with WRF25-49% and WRF≥50%: HFpEF, 1.101 (0.913 to 1.328) and
2.096 (1.652 to 2.659), in HFmrEF 1.654 (1.353 to 2.022) and 2.375 (1.807 to 3.122)
and in HFrEF 1.212 (1.060 to 1.386) and 1.694 (1.412 to 2.033). In conclusion, the
long-term WRF risk was high in HF and highest in HFpEF. WRF was strongly associated
with mortality in all EF groups, although in HFpEF only with the most severe WRF.
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References
- Candesartan in heart failure: assessment of reduction in M, morbidity I. Renal function as a predictor of outcome in a broad spectrum of patients with heart failure.Circulation. 2006; 113: 671-678
- Prevalence and prognostic impact of kidney disease on heart failure patients.Open heart. 2016; 3e000324
- Worsening renal function in patients hospitalised for acute heart failure: clinical implications and prognostic significance.Eur J Heart Fail. 2008; 10: 188-195
- Terminology and definition of changes renal function in heart failure.Eur Heart J. 2014; 35: 3413-3416
- Incidence of renal dysfunction over 6 months in patients with chronic heart failure due to left ventricular systolic dysfunction: contributing factors and relationship to prognosis.Eur Heart J. 2006; 27: 569-581
- Progression of renal impairment and chronic kidney disease in chronic heart failure: an analysis from GISSI-HF.J Card Fail. 2017; 23: 2-9
- Changes in renal function during hospitalization and soon after discharge in patients admitted for worsening heart failure in the placebo group of the EVEREST trial.Eur Heart J. 2011; 32: 2563-2572
- Both in- and out-hospital worsening of renal function predict outcome in patients with heart failure: results from the Coordinating Study Evaluating Outcome of Advising and Counseling in Heart Failure (COACH).Eur J Heart Fail. 2009; 11: 847-854
- Incidence, predictors at admission, and impact of worsening renal function among patients hospitalized with heart failure.J Am Coll of Cardiol. 2004; 43: 61-67
- Renal impairment, worsening renal function, and outcome in patients with heart failure: an updated meta-analysis.Eur Heart J. 2014; 35: 455-469
- The role of the kidney in heart failure.Eur Heart J. 2012; 33: 2135-2142
- A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation.J Am Coll of Cardiol. 2013; 62: 263-271
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.Eur Heart J. 2016; 37: 2129-2200
- A comprehensive population-based characterization of heart failure with mid-range ejection fraction.Eur J Heart Fail. 2017; 19: 1624-1634
- Heart failure registry: a valuable tool for improving the management of patients with heart failure.Eur J Heart Fail. 2010; 12: 25-31
- The Stockholm CREAtinine Measurements (SCREAM) project: protocol overview and regional representativeness.Clin Kidney J. 2016; 9: 119-127
- The chronic kidney disease epidemiology collaboration equation outperforms the modification of diet in renal disease equation for estimating glomerular filtration rate in chronic systolic heart failure.Eur J Heart Fail. 2014; 16: 86-94
- Worsening of renal function during 1 year after hospital discharge is a strong and independent predictor of all-cause mortality in acute decompensated heart failure.JAHA. 2014; 3e001174
- Postdischarge assessment after a heart failure hospitalization: the next step forward.Circulation. 2010; 122: 1782-1785
- 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: 1606-1614
- Connecting heart failure with preserved ejection fraction and renal dysfunction: the role of endothelial dysfunction and inflammation.Eur J Heart Fail. 2016; 18: 588-598
- Increased central venous pressure is associated with impaired renal function and mortality in a broad spectrum of patients with cardiovascular disease.J Am Coll of Cardiol. 2009; 53: 582-588
- Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology.Eur J Heart Fail. 2018; 20: 16-37
- Association of chronic kidney disease with abnormal cardiac mechanics and adverse outcomes in patients with heart failure and preserved ejection fraction.Eur J Heart Fail. 2016; 18: 103-112
- Association of chronic kidney disease with chronotropic incompetence in heart failure with preserved ejection fraction.Am J Cardiol. 2015; 116: 1093-1100
- Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF).Circ Heart Fail. 2014; 7: 51-58
- Significance of ischemic heart disease in patients with heart failure and preserved, midrange, and reduced ejection fraction: a nationwide cohort study.Circ Heart Fail. 2017; 10
- What have we learned about heart failure with mid-range ejection fraction one year after its introduction?.Eur J Heart Fail. 2017; 19: 1569-1573
- Chronic kidney disease and worsening renal function in acute heart failure: different phenotypes with similar prognostic impact?.Eur Heart J Acute Cardiovasc Care. 2016; 5: 534-548
Article info
Publication history
Published online: August 22, 2019
Received in revised form:
July 29,
2019
Received:
May 21,
2019
Footnotes
Funding: This work was supported by the Swedish Foundation for Strategic Research, the Swedish Heart and Lung Foundation, Olausson's Foundation and the Stockholm County Council (ALF project).
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