Heart failure & cardiomyopathiesCohort study
Outcomes of KDIGO-Defined Chronic Kidney Disease (CKD) in U.S. Veterans With Heart Failure with Preserved Ejection Fraction (HFpEF), Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF), and Heart Failure with Reduced Ejection Fraction (HFrEF)
- Retrospective cohort study
- national Veterans Affairs electronic health record data
Authors' conclusion
These findings based on KDIGO-defined CKD and NKF provide new information about the best estimates of true prevalence and outcomes of CKD in HFpEF, HFmrEF, and HFrEF.
Study context
- Population
- US veterans with heart failure (HF) (1991–2017) and EF data: HFpEF (EF ≥50%, n = 85,855), HFmrEF (EF 41%-49%, n = 39,397), HFrEF (EF ≤40%, n = 139,748)of 1,446,053 veterans with HF
- Participants
- 365,000 veterans
- Exposure
- KDIGO-defined CKD vs normal kidney function, by EF category
- Outcome
- All-cause mortality and HF hospitalization
- Follow-up
- 5 years
Main finding
As reported in the abstract
CKD vs NKF, multivariable-adjusted risk
- Death, HFpEF: higher risk with CKD
- 16%
- Death, HFmrEF: higher risk with CKD
- 19%
- Death, HFrEF: higher risk with CKD
- 26%
- HF hospitalization, HFpEF: higher risk with CKD
- 31%
- HF hospitalization, HFmrEF: higher risk with CKD
- 33%
- HF hospitalization, HFrEF: higher risk with CKD
- 32%
Observational data: associations, not effects.
Further findings
Outcomes in Normal Kidney Function (NKF) (HFpEF, HFmrEF, HFrEF)
- Mortality HFpEF
- 39%
- Mortality HFmrEF
- 37%
- Mortality HFrEF
- 41%
- HF hospitalization HFpEF
- 12%
- HF hospitalization HFmrEF
- 15%
- HF hospitalization HFrEF
- 21%
Albuminuria vs NKF, multivariable-adjusted risk
- Death, HFpEF
- 16%
- Death, HFmrEF
- 10%
- Death, HFrEF
- 12%
- HF hospitalization, HFpEF
- 29
- HF hospitalization, HFmrEF
- 30%
- HF hospitalization, HFrEF
- 24%
Estimated glomerular filtration rate (eGFR) stages
- Risks incrementally higher with decreasing eGFR, except eGFR <15 mL/min/1.73 m² (likely dialysis initiation)
Original publication
Outcomes of KDIGO-Defined CKD in U.S. Veterans With HFpEF, HFmrEF, and HFrEF. JACC Heart Fail. Published 5 February 2025. doi:10.1016/j.jchf.2024.11.007
Summarised from the published abstract; every number is checked against it