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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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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