Progression of Renal Impairment and Chronic Kidney Disease in Chronic Heart Failure: An Analysis From GISSI-HF

Abstract

Background: Data on the natural change in renal function in patients with chronic heart failure (HF) are limited.

Methods and results: Estimated glomerular filtration rate (eGFR) was assessed over 36 months in 6934 patients included in the GISSI-HF study. Associations from baseline, changes in renal function, and occurrence of cardiovascular death or HF hospitalization were assessed. Mean age was 67 years, mainly men (78%), and mean eGFR was 68 mL • min^-1 • 1.73 m^-2. Change in eGFR in the 1st year was -1.5 ± 16 mL • min^-1 • 1.73 m^-2, and over 36 months it was -3.7 ± 18 mL • min^-1 • 1.73 m^-2. Over the latter period, only 25% deteriorated ≥1 Kidney Disease Outcomes Quality Initiatives (KDOQI) class of chronic kidney disease (CKD). Fifteen percent of patients had >15 mL • min^-1 • 1.73 m^-2 decrease in eGFR in the 1st 12 months. Lower eGFR was associated with outcome: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.08-1.10 (P < .001) per 10 mL • min^-1 • 1.73 m^-2 decrease, as well as every 10 mL • min^-1 • 1.73 m^-2 decrease over the 1st year (HR 1.10, 95% CI 1.04-1.17; P < .001). A deterioration in eGFR >15 mL • min^-1 • 1.73 m^-2 in the 1st year showed the highest risk of events (HR 1.22, 95% CI 1.10-1.36; P < .001).

Conclusions: Mean decrease in renal function over time in patients with chronic HF was modest. Only 25% deteriorated ≥1 KDOQI class of CKD after 3 years. Any decrease in eGFR over time was associated with strongly increased event rates.

Keywords: Renal function; chronic heart failure; chronic kidney disease; prognosis.