Heart failure & cardiomyopathiesCohort study
Kidney dysfunction and pulmonary vascular disease in heart failure with preserved ejection fraction
- Cohort study
- consecutive patients
- invasive hemodynamic cardiopulmonary exercise testing
Authors' conclusion
Kidney dysfunction in patients with HFpEF is characterized by more severe pulmonary vascular disease at rest and with exercise, leading to reduced cardiac output reserve, impaired exercise capacity, and increased risk for adverse events.
Study context
- Population
- Patients with HFpEF undergoing invasive hemodynamic cardiopulmonary exercise testing319 (34.5%) eGFR < 60
- Participants
- 925 patients
- Exposure
- Strata of kidney function in HFpEF
Main finding
As reported in the abstract
Pulmonary vascular disease at rest
| Group | Pulmonary vascular resistance (PVR) | PA compliance (PAC) |
|---|---|---|
| eGFR ≥ 90 | 1.3 [0.86, 1.88] WU | 4.7 [3.6, 5.8] ml/mmHg |
| eGFR < 30 | 2.8 [2.0, 3.8] WU | 2.2 [1.8, 3.4] ml/mmHg |
- PVR increase with worsening kidney function
- P < 0.001
- PAC decrease with worsening kidney function
- P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Composite of all-cause death and HF hospitalisation — eGFR 60-90 vs eGFR ≥ 90 | 2.38 (1.01–5.59) | |
| Composite of all-cause death and HF hospitalisation — eGFR < 30 vs eGFR ≥ 90 | 16.77 (6.65–42.28) | |
| 0.050.21520Hazard ratio (log scale) |
Exercise haemodynamics
- With exercise, more severe elevation in pulmonary arterial (PA) pressures and PVR, lower PA compliance, no difference in exertional PA wedge pressure with worse kidney function
- Greatest cardiac output limitation and impaired aerobic capacity with worse kidney dysfunction
Original publication
Kidney dysfunction and pulmonary vascular disease in heart failure with preserved ejection fraction. Eur J Heart Fail. Published 27 April 2026. doi:10.1093/ejhf/xuag140
Summarised from the published abstract; every number is checked against it