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Association between chronic kidney disease and heart failure across the ejection fraction spectrum: a retrospective
Valeria Valente1, Lina Benson1,2, Carin Corovic Cabrera1
1Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm South Hospital, Sjukhusbacken 10, Stockholm 118 83, Sweden.
Insights
Chronic kidney disease (CKD) significantly increases the risk of heart failure (HF), particularly HF with preserved ejection fraction (HFpEF). Early CKD management is vital for preventing HF development.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Heart failure (HF) and chronic kidney disease (CKD) frequently coexist.
- The specific association between CKD and HF phenotypes (based on ejection fraction) is not well understood.
Purpose of the Study:
- To investigate the link between CKD and new-onset HF across the spectrum of ejection fraction.
- To examine this association based on CKD severity.
Main Methods:
- Utilized the Swedish Heart Failure Registry (2005-2021) with 1:1 matched controls.
- Defined CKD using ICD-10 codes and estimated glomerular filtration rate (eGFR < 60 mL/min/1.73m²).
- Stratified renal function into KDIGO categories (G2-G5) for detailed analysis.
Main Results:
- CKD was associated with approximately double the odds of HF compared to controls.
- CKD showed a stronger association with HFpEF compared to HFmrEF and HFrEF.
- Moderate to advanced CKD (G3b-G5) was linked to higher odds of HFpEF versus HFrEF.
Conclusions:
- CKD is an independent risk factor for new-onset HF, especially HFpEF.
- The association varies with CKD severity, with HFpEF particularly affected in moderate to advanced stages.
- Interventions targeting CKD are crucial for HF prevention.
Background And Aims:
Heart failure (HF) and chronic kidney disease (CKD) are prevalent and often co-exist. Whether CKD is preferentially associated with a specific HF ejection fraction (EF) phenotype remains unclear. We aimed to investigate the association between CKD and new-onset HF across the EF spectrum and according to CKD severity.
Methods:
Patients with a first HF diagnosis from the Swedish HF Registry (2005-2021) were matched 1:1 by sex, year of birth, and county to controls without HF. In separate analyses, CKD was defined according to (i) ICD-10 codes in both HF patients and controls; (ii) an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 in HF patients. Renal function was further stratified into the KDIGO categories G2-G5, i.e. G2:60-89;G3a:45-59; G3b:30-44; G4:15-29; G5 < 15 ml/min/1.73 m2 in eGFR-defined CKD analyses.
Results:
51 848 HF patients (20% HF with preserved EF [HFpEF], 23% HF with mildly reduced EF [HFmrEF], 57% HF with reduced EF [HFrEF]) and 51 848 controls were considered. CKD was associated with ∼two-fold higher odds of HF, particularly HFpEF, compared with HFmrEF and HFrEF vs non-HF (ICD-10 definition: odds ratio [OR]2.46, 1.30, and 1.52, respectively; P-interaction=0.001) and with 8% higher odds of HFpEF vs HFrEF when defined by eGFR in the HF population. Across KDIGO stages, with G2 as reference, G3b-G5 were more likely associated with HFpEF vs HFrEF, G3a had similar associations with HFpEF and HFrEF, and G3a-G3b were less likely associated with HFmrEF vs. HFrEF.
Conclusions:
CKD was independently associated with new-onset HF, especially HFpEF in moderate to advanced CKD, and both HFpEF and HFrEF in mild CKD. Targeting CKD may be crucial to prevent HF.
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