Related Experiment Video
Updated: May 29, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Outcomes of KDIGO-Defined CKD in U.S. Veterans With HFpEF, HFmrEF, and HFrEF
Samir Patel1, Venkatesh K Raman2, Charles Faselis3
1Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA.
Insights
Chronic kidney disease (CKD) significantly increases mortality and hospitalization risks in heart failure (HF) patients across all ejection fraction types. These risks escalate with declining kidney function, highlighting the importance of managing CKD in HF care.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Chronic kidney disease (CKD), defined by KDIGO guidelines, is linked to adverse outcomes in heart failure (HF) patients.
- The impact of CKD on outcomes across different left ventricular ejection fraction (LVEF) categories in HF is not fully understood.
Purpose of the Study:
- To determine the prevalence and outcomes of KDIGO-defined CKD in patients with heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF).
Main Methods:
- A large cohort of 1,446,053 veterans with HF was analyzed using electronic health records from 1991-2017.
- CKD was identified based on estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² or albuminuria, with normal kidney function (NKF) as a comparator.
- Cox regression models estimated 5-year all-cause mortality and HF hospitalization risks associated with CKD categories across HFpEF, HFmrEF, and HFrEF groups.
Main Results:
- CKD was associated with significantly higher risks of death (16-26%) and HF hospitalization (31-33%) compared to NKF across all HF subtypes.
- These risks increased progressively with lower eGFR levels, except for eGFR <15 mL/min/1.73 m², potentially due to dialysis initiation.
- Albuminuria also independently increased mortality (10-16%) and HF hospitalization (24-30%) risks in all HF groups.
Conclusions:
- KDIGO-defined CKD is prevalent and associated with substantially worse outcomes in patients with HFpEF, HFmrEF, and HFrEF.
- These findings underscore the critical need to consider and manage CKD in heart failure patients, irrespective of their ejection fraction.
- The study provides valuable insights into the true prevalence and prognostic impact of CKD in diverse HF populations.
Background:
Chronic kidney disease (CKD) is defined by the KDIGO (Kidney Disease: Improving Global Outcomes) guideline as abnormal kidney structure or function, present for >3 months, with implications for health. KDIGO-defined CKD is associated with poor outcomes in patients with heart failure (HF). Less is known about whether these associations vary by left ventricular ejection fraction.
Objectives:
This study aims to determine the prevalence and outcomes of KDIGO-defined CKD in heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF).
Methods:
Of the 1,446,053 veterans with an HF diagnosis (1991-2017) in the national Veterans Affairs electronic health record data, 365,000 with data on EF had KDIGO-defined CKD or normal kidney function (NKF). CKD was defined as 2 values measured 90 days apart of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 (categorized into 4 eGFR stages based on the last eGFR: 45-59 mL/min/1.73 m2, 30-44 mL/min/1.73 m2, 15-29 mL/min/1.73 m2, and <15 mL/min/1.73 m2) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (albuminuria). NKF was defined as 2 values measured >90 days apart of eGFR ≥60 mL/min/1.73 m2, without eGFR <60 mL/min/1.73 m2 or albuminuria for 3 years before HF diagnosis. Patients were categorized into HFpEF (EF ≥50%, n = 85,855), HFmrEF (EF 41%-49%, n = 39,397), and HFrEF (EF ≤40%, n = 139,748). HRs and 95% CIs for 5-year all-cause mortality and HF hospitalization through December 31, 2022, associated with the 5 CKD groups (vs NKF) were estimated using Cox regression.
Results:
Among patients with HF and NKF, mortality occurred in 39%, 37%. and 41%, and HF hospitalization occurred in 12%, 15%, and 21% of those with HFpEF, HFmrEF. and HFrEF, respectively. Compared with NKF, CKD was associated with 16%, 19%, and 26% higher multivariable-adjusted risks for death in patients with HFpEF, HFmrEF, and HFrEF, respectively. Respective risks for HF hospitalization were 31%, 33%, and 32% higher. The eGFR-associated risks were incrementally higher with decreasing eGFR, except for eGFR <15 mL/min/1.73 m2, likely because of the initiation of dialysis during follow-up. Albuminuria was associated with 16%, 10%, and 12% higher multivariable-adjusted risks for death and 29, 30%, and 24% for HF hospitalization in HFpEF, HFmrEF, and HFrEF, respectively. All associations were statistically significant.
Conclusions:
These findings based on KDIGO-defined CKD and NKF provide new information about the best estimates of true prevalence and outcomes of CKD in HFpEF, HFmrEF, and HFrEF.
Related Concept Videos
01:22Heart Failure Drugs: Diuretics
01:17Pathophysiology of Heart Failure
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:26Heart Failure Drugs: Inotropic Agents
01:33Hormonal Regulation
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...