Heart failure with preserved ejection fraction prevalent among patients with CKD
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Key takeaways
- Researchers observed prevalent heart failure among patients with incident CKD.
- Heart failure correlated with 1-year all-cause and cardiovascular-related mortality.
Among patients with chronic kidney disease, heart failure with preserved ejection fraction was highly prevalent, according to data published in Kidney Medicine.
Further, the presence of heart failure correlated with 1year all-cause and cardiovascular-related mortality among this population.
“One of the primary manifestations of cardiovascular disease is heart failure, which has a bidirectional interaction with CKD, termed ‘cardiorenal syndrome’ Up to 40% of CKD patients who initiate dialysis have heart failure and among those without heart failure, the annual incidence is estimated at 20%,” Albert S. Yu, MD, PhD, from the Permanente Los Angeles Medical Center, and colleagues wrote. “A better understanding of the epidemiology of patients with cardiorenal syndrome, may improve ways to provide targeted management strategies to this vulnerable population.”
In a retrospective cohort study, researchers examined data of 76,688 patients with incident CKD between 2007 and 2017 within Kaiser Permanente Southern California. The study population included patients with and without heart failure.
Researchers compared patient characteristics among those with CKD without heart failure and those with it, then categorized them as heart failure with preserved ejection fraction (HRpEF) or heart failure with reduced ejection fraction (HFrEF).
With heart failure alone, HFpEF or HFrEF serving as the exposures, researchers considered all-cause and cardiovascular-related mortality within a year of CKD identification the primary outcome.
Using Cox proportional hazards model, researchers determined the hazard ratios for risk of all-cause mortality. Similarly, they used Fine-Gray sub distribution hazard model to measure the risk of cardiovascular-related mortality within year.
Overall, 18.6% of had prevalent heart failure, of which 59.2% had HFpEF and 23.3% had HFrEF. Analyses revealed the hazard ratio for 1year all-cause mortality among patients with heart failure was 1.70 compared those without heart failure. Further, the HRs for patients with HFpEF and HRrEF were 1.59 and 2.43, respectively.
Among patients with heart failure, the HR for 1year cardiovascular-related mortality was 6.69, compared patients without . Researchers noted that cardiovascular-related mortality was higher (11.47) among patients with HFrEF.
“Given the advancements in therapies for heart failure such as neprilysin inhibitors, SGLT2 inhibitors, and newergeneration mineralocorticoid receptor antagonists, future studies are needed to assess the efficacy of these drugs in realworld populations,” Yu and colleagues wrote. “We hope that such future work will provide more insights into the evolving care for heart failure and CKD, ultimately to help better understand and manage this vulnerable population.”
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