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Anemia has an impact on prognosis in heart failure with preserved ejection fraction with mild chronic kidney disease

Keisuke Okuno1, Yoshiro Naito1, Masanori Asakura1

  • 1Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.

International Journal of Cardiology. Heart & Vasculature
|June 7, 2021
PubMed

Insights

Anemia significantly impacts prognosis in heart failure with preserved ejection fraction (HFpEF) patients who also have chronic kidney disease (CKD). Optimal hemoglobin levels are crucial for predicting outcomes, particularly in those with mild CKD.

Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • Heart failure with preserved ejection fraction (HFpEF) frequently co-occurs with anemia and chronic kidney disease (CKD).
  • The prognostic impact of anemia in HFpEF patients with CKD remains largely uncharacterized.
  • This study investigates anemia's effect on prognosis and optimal hemoglobin levels in HFpEF patients with CKD.

Purpose of the Study:

  • To determine the impact of anemia on prognosis in patients with HFpEF and CKD.
  • To identify optimal hemoglobin levels for predicting prognosis in this patient cohort.
  • To explore how the degree of CKD influences the relationship between anemia and prognosis.

Main Methods:

  • Prospective study of 523 HFpEF patients from the Japanese HFpEF registry.
  • CKD defined by estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m²).
  • Kaplan-Meier, multivariate, and survival classification/regression tree analyses were employed.

Main Results:

  • Anemia prevalence was 78% in HFpEF patients with CKD.
  • Anemic patients with HFpEF and CKD showed poorer prognosis (mortality, rehospitalization) than non-anemic patients.
  • Anemia impacted prognosis in mild CKD (45 ≤ eGFR < 60) but not moderate-to-severe CKD (15 ≤ eGFR < 45).
  • Anemia and hemoglobin levels were independent predictors of outcomes in mild CKD.
  • Optimal hemoglobin level for predicting composite outcomes in mild CKD was 10.7 g/dL.

Conclusions:

  • Anemia significantly affects prognosis in HFpEF patients.
  • The prognostic impact of anemia is particularly pronounced in HFpEF patients with mild CKD.
  • Specific hemoglobin targets may be beneficial for predicting outcomes in this subgroup.
Abstract

Keywords:
AnemiaChronic kidney diseaseHeart failure with preserved left ventricular ejection fractionHemoglobin

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