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Comparative Study
. 2013 May 1;6(3):333-42.
doi: 10.1161/CIRCOUTCOMES.113.000221. Epub 2013 May 17.

Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study

David H Smith  1 , Micah L Thorp, Jerry H Gurwitz, David D McManus, Robert J Goldberg, Larry A Allen, Grace Hsu, Sue Hee Sung, David J Magid, Alan S Go
Affiliations
Comparative Study

Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study

David H Smith et al. Circ Cardiovasc Qual Outcomes. .

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 m(2), 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 m(2) and 7× higher for eGFR<15 mL/min per 1.73 m(2), 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.

Keywords: chronic kidney disease; heart failure; hospitalization; mortality.

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Figures

Figure 1
Figure 1
Patient flow diagram. eGFR indicates estimated glomerular filtration rate.
Figure 2
Figure 2
Crude probability of survival among 24 331 adults with heart failure and preserved or reduced left ventricular ejection fraction stratified by levels of renal function. eGFR indicates estimated glomerular filtration rate.
Figure 3
Figure 3
Crude probability of survival free of hospitalization for heart failure among 24 331 adults with heart failure and preserved or reduced left ventricular ejection fraction stratified by levels of renal function. eGFR indicates estimated glomerular filtration rate.
Figure 4
Figure 4
Crude probability of survival free of hospitalization from any cause among adults with heart failure and preserved or reduced left ventricular ejection fraction stratified by levels of renal function. eGFR indicates estimated glomerular filtration rate.
See this image and copyright information in PMC

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