WASHINGTON, DC — Chronic kidney disease (CKD) is defined by the KDIGO (Kidney Disease: Improving Global Outcomes) guideline as abnormal kidney structure or function, present for more than 3 months, with implications for health.
While is it understood that KDIGO-defined CKD is associated with poor outcomes in patients with heart failure (HF), not as much is known about whether these associations vary by left ventricular ejection fraction, according to a new study in JACC Heart Failure.
Researchers from the Washington, DC, VAMC and colleagues sought to determine the prevalence and outcomes of KDIGO-defined CKD in heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with reduced ejection fraction (HFrEF). VAMCS from Palo Alto, CA, and Providence, RI, also participated in the study.
Of the about 1.4 million veterans with an HF diagnosis (1991-2017) in the national VA electronic health record data, 365,000 with data on EF had KDIGO-defined CKD or normal kidney function (NKF).
The researchers defined CKD as 2 values measured 90 days apart from estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 (categorized into 4 eGFR stages based on the last eGFR: 45-59 mL/min/1.73 m2, 30-44 mL/min/1.73 m2, 15-29 mL/min/1.73 m2 and <15 mL/min/1.73 m2) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (albuminuria).
NKF was defined as 2 values measured >90 days apart from eGFR ≥60 mL/min/1.73 m2, without eGFR <60 mL/min/1.73 m2 or albuminuria for 3 years before HF diagnosis.
The study team categorized patients into:
- HFpEF (EF ≥50%, n = 85,855),
- HFmrEF (EF 41%-49%, n = 39,397) and
- HFrEF (EF ≤40%, n = 139,748).
Among patients with HF and NKF, the study found that mortality occurred in 39%, 37% and 41%, and HF hospitalization occurred in 12%, 15% and 21% of those with HFpEF, HFmrEF and HFrEF, respectively.
“Compared with NKF, CKD was associated with 16%, 19%, and 26% higher multivariable-adjusted risks for death in patients with HFpEF, HFmrEF, and HFrEF, respectively,” the authors wrote. “Respective risks for HF hospitalization were 31%, 33%, and 32% higher. The eGFR-associated risks were incrementally higher with decreasing eGFR, except for eGFR <15 mL/min/1.73 m2, likely because of the initiation of dialysis during follow-up. Albuminuria was associated with 16%, 10%, and 12% higher multivariable-adjusted risks for death and 29, 30%, and 24% for HF hospitalization in HFpEF, HFmrEF, and HFrEF, respectively. All associations were statistically significant.”
The researchers pointed out that their findings based on KDIGO-defined CKD and NKF provide new information about the best estimates of true prevalence and outcomes of CKD in HFpEF, HFmrEF and HFrEF.
- Patel S, Raman VK, Faselis C, Fonarow GC, et. Al. Outcomes of KDIGO-Defined CKD in U.S. Veterans With HFpEF, HFmrEF, and HFrEF. JACC Heart Fail. 2025 Jan 24:S2213-1779(24)00870-9. doi: 10.1016/j.jchf.2024.11.007. Epub ahead of print. PMID: 39918536.
