Marta Cobo Marcos, Rafael de la Espriella, Jara Gayán Ordás, Pau Llàcer, Isabel Zegrí-Reiriz, Aleix Fort, Inés Ponz de Antonio, Ana Méndez, Zorba Blázquez-Bermejo, Pedro Caravaca Pérez, Jorge Rubio Gracia, Alejandro Recio-Mayoral, José Manuel García Pinilla, Esther Montero Hernández, Almudena Castro, María José Soler, José Luis Górriz, Ramón Bascompte Claret, Paula Fluvià-Brugués, Luis Manzano, Julio Núñez
In this contemporary CHF population, worse kidney function identified patients with a more adverse clinical profile and poorer outcomes, although these associations were attenuated after adjustment for congestion markers and disease severity.
INTRODUCTION AND OBJECTIVES: Kidney dysfunction is common in chronic heart failure (CHF), but its prognostic significance in contemporary populations remains uncertain. We evaluated 1-year outcomes according to kidney function stage and the prognostic role of the estimated glomerular filtration rate (eGFR).
METHODS: We analyzed 1105 patients with CHF enrolled in the CARDIOREN Registry (13 centers, 2021-2022). Kidney function was categorized according to CKD-EPI eGFR (≥ 60, 30-59, < 30 mL/min/1.73 m²). The primary endpoint was the composite of all-cause death or worsening heart failure at 1 year; all-cause mortality was analyzed separately. Associations were assessed using multivariable Cox regression models with fractional polynomial modeling.
RESULTS: Median age was 75 years, 63% of patients were men, and 38% had heart failure with preserved ejection fraction. Overall, 59% had eGFR < 60 mL/min/1.73 m². At 1 year, the composite endpoint occurred in 24% of patients, and all-cause mortality occurred in 13%. Event rates increased progressively with worsening kidney function categories for the primary endpoint (11%, 31%, and 38%; P < .001) and for all-cause mortality (4%, 16%, and 26%; P < .001). In multivariable analysis, N-terminal pro-B-type natriuretic peptide, hemoglobin, and furosemide-equivalent dose were independently associated with both outcomes. Hemoglobin showed a U-shaped association, with higher risk at both low and high concentrations. CA125 was independently associated with all-cause mortality. eGFR was not independently associated with the composite endpoint but remained independently associated with all-cause mortality, showing a nonlinear inverse relationship.
CONCLUSIONS: In this contemporary CHF population, worse kidney function identified patients with a more adverse clinical profile and poorer outcomes, although these associations were attenuated after adjustment for congestion markers and disease severity.