Heart Failure Increases the Risk of Adverse Renal Outcomes in Patients With Normal Kidney Function

Abstract

Background: Heart failure (HF) is associated with poor cardiac outcomes and mortality. It is not known whether HF leads to poor renal outcomes in patients with normal kidney function. We hypothesized that HF is associated with worse long-term renal outcomes.

Methods and results: Among 3 570 865 US veterans with estimated glomerular filtration rate (eGFR) ≥60 mL min^-1 1.73 m^-2 during October 1, 2004 to September 30, 2006, we identified 156 743 with an International Classification of Diseases, Ninth Revision, diagnosis of HF. We examined the association of HF with incident chronic kidney disease (CKD), the composite of incident CKD or mortality, and rapid rate of eGFR decline (slopes steeper than -5 mL min^-1 1.73 m^-2 y^-1) using Cox proportional hazard analyses and logistic regression. Adjustments were made for various confounders. The mean±standard deviation baseline age and eGFR of HF patients were 68±11 years and 78±14 mL min^-1 1.73 m^-2 and in patients without HF were 59±14 years and 84±16 mL min^-1 1.73 m^-2, respectively. HF patients had higher prevalence of hypertension, diabetes mellitus, cardiac, peripheral vascular and chronic lung diseases, stroke, and dementia. Incidence of CKD was 69.0/1000 patient-years in HF patients versus 14.5/1000 patient-years in patients without HF, and 22% of patients with HF had rapid decline in eGFR compared with 8.5% in patients without HF. HF patients had a 2.12-, 2.06-, and 2.13-fold higher multivariable-adjusted risk of incident CKD, composite of CKD or mortality, and rapid eGFR decline, respectively.

Conclusions: HF is associated with significantly higher risk of incident CKD, incident CKD or mortality, and rapid eGFR decline. Early diagnosis and management of HF could help reduce the risk of long-term renal complications.

Keywords: glomerular filtration rate; heart failure; incidence; kidney diseases; mortality; renal insufficiency; veterans.

Figure 1

Flow chart of patient selection

Figure 2

Association between HF and the risk of incident CKD in various subgroups. Adjusted for baseline age, gender, race/ethnicity, marital status, income level, service connection and non-compliance, diabetes mellitus, hypertension, cardiovascular disease, peripheral arterial disease, lung disease and malignancy, body mass index, systolic blood pressure and diastolic blood pressure and eGFR. The light and dark markers denote the hazard ratio and 95% confidence intervals of two categories of the same variable.

Figure 3

Association between HF and the risk of the composite endpoint of incident CKD or mortality in various subgroups. Adjusted for baseline age, gender, race/ethnicity, marital status, income level, service connection and non-compliance, diabetes mellitus, hypertension, cardiovascular disease, peripheral arterial disease, lung disease and malignancy, body mass index, systolic blood pressure and diastolic blood pressure and eGFR. The light and dark markers denote the hazard ratio and 95% confidence intervals of two categories of the same variable.

Figure 4

Association between HF and the risk of rapid decline in eGFR (≥5 ml/min/1.73m²/year) in various subgroups. Adjusted for baseline age, gender, race/ethnicity, marital status, income level, service connection and non-compliance, diabetes mellitus, hypertension, cardiovascular disease, peripheral arterial disease, lung disease and malignancy, body mass index, systolic blood pressure and diastolic blood pressure and eGFR. The light and dark markers denote the odds ratio and 95% confidence intervals of two categories of the same variable.