Echocardiographic features of left ventricular dysfunction and outcomes in chronic kidney disease

Area of Science:

• Cardiology
• Nephrology
• Clinical Research

Background:

• Heart failure (HF) is prevalent in patients with chronic kidney disease (CKD), contributing to significant healthcare burdens.
• The impact of different HF subtypes on long-term outcomes and renal function in CKD patients remains incompletely understood.

Purpose of the Study:

• To investigate the association between HF subtypes and long-term clinical outcomes, including mortality, major adverse cardiovascular events (MACEs), and adverse renal outcomes in patients with CKD.

Main Methods:

• A cohort of 10,904 CKD patients aged ≥20 years who underwent echocardiography between 2011 and 2018 was analyzed.
• Patients were stratified into four groups: non-HF, HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF).
• Outcomes were assessed using inverse probability of treatment weighting (IPTW) adjusted analyses.

Main Results:

• Compared to the non-HF group, HFrEF was associated with the highest risks of all-cause mortality (HR 3.18) and MACEs (HR 3.83).
• HFmrEF and HFpEF also showed increased risks for mortality and MACEs, with HFrEF demonstrating the most significant elevation.
• The HFrEF group exhibited the greatest risk for end-stage renal disease (HR 2.58) compared to other HF subtypes and the non-HF group.

Conclusions:

• Heart failure is linked to poorer clinical outcomes in CKD patients.
• The severity of adverse outcomes increases with HF subtype, with HFrEF posing the greatest risk, followed by HFmrEF and HFpEF, relative to patients without HF.