Renal function trajectories in 'De Novo' heart failure with reduced ejection fraction: impact on outcomes

Heart failure (HF) often coexists with chronic kidney disease (CKD), impacting prognosis. This study aims to evaluate renal function trajectories and their impact on major clinical outcomes in a cohort of patients hospitalised for 'de novo' HF with reduced ejection fraction (HFrEF).

This is a prospective cohort study that included patients hospitalised for 'de novo' HFrEF at two university hospitals. Renal function was assessed using the CKD-Epidemiology Collaboration formula. Total mortality and the combined total mortality and HF readmissions were evaluated during follow-up.

Of 370 patients, 306 were eligible. At discharge, 24.6% had estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m². Higher eGFR at discharge was associated with better outcomes. During follow-up, 79.1% showed eGFR ≥45 mL/min/1.73 m². Patients with stable or improved eGFR had lower total mortality and HF readmission rates. Factors associated with renal function improvement or stabilisation included less prior CKD, hypertension and younger age, higher eGFR values at discharge and more use of quadruple therapy at the end of uptitration period.

In patients with 'de novo' HFrEF, renal function deterioration at discharge correlated with poorer outcomes. However, stabilisation or improvement during follow-up was linked to better prognosis. Routine renal function assessment is crucial in HFrEF management, guiding personalised treatment strategies to mitigate renal function decline and improve patient care.