Heart failure & cardiomyopathies

Kidney Status and Events Preceding Death in Heart Failure: A Real-World Nationwide Study

Eur J Heart FailPublished Retrospective cohort study

Authors' conclusion

In HF patients, AKI and ESKD are common in the last year of life, particularly in those with lower baseline eGFR, with kidney decline accelerating in the final months.

Study context

Population
Heart failure (HF) patients who died 2014–2021 with ≥1 year of HF diagnosisHF patients who died
Participants
36,435 patients
Exposure
Estimated glomerular filtration rate (eGFR) categories 1 year before death
Outcome
Adverse kidney events (AKI and ESKD) preceding death
Follow-up
Last year of life
Methodological detailsnationwide registry
  • Nationwide registry

Main finding

As reported in the abstract

AKI and ESKD by eGFR 1 year before death
GroupAcute kidney injury (AKI)End-stage kidney disease (ESKD)
eGFR ≥606.5% (95% CI 6.1-6.9)0.7% (0.6-0.9)
eGFR 30-597.0% (6.6-7.4)2.6% (2.4-2.8)
eGFR <3021.9% (20.9-22.9)35.5% (34.3-36.7)

Acute kidney injury (AKI)

eGFR ≥606.5% (95% CI 6.1-6.9)
eGFR 30-597.0% (6.6-7.4)
eGFR <3021.9% (20.9-22.9)

End-stage kidney disease (ESKD)

eGFR ≥600.7% (0.6-0.9)
eGFR 30-592.6% (2.4-2.8)
eGFR <3035.5% (34.3-36.7)
Adverse kidney events, all patients
13.1%

Observational data: associations, not effects.

Further findings

Distribution of eGFR categories 1 year before death

Kidney function in the last 3 months before death

Kidney function notably declined, with increased chronic kidney replacement therapy

Factors associated with more adverse kidney events

Younger age, male sex, in-hospital death and greater frailty

Original publication

Kidney Status and Events Preceding Death in Heart Failure: A Real-World Nationwide Study. Eur J Heart Fail. Published 2 March 2025. doi:10.1002/ejhf.3631

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