March 3, 2026

Impact of chronic kidney disease on treatment implementation and prognosis of patients with heart failure: A large retrospective observational analysis from the Italian Network-Heart Failure (IN-HF) registry

Puntos clave

Heart failure prognosis worsens significantly in patients with chronic kidney disease, indicating a serious clinical concern.
Patients with chronic kidney disease have reduced treatment implementation rates, complicating heart failure management strategies.

PICO estructurado

Does advanced chronic kidney disease (stage 4-5 vs stage 3b) increase the risk of adverse cardiovascular outcomes in outpatients with heart failure?

Población

2,003 outpatients with chronic heart failure and chronic kidney disease (KDIGO stage 3b [eGFR 30-44 ml/min/1.73 m²] and stages 4-5 [eGFR <30 ml/min/1.73 m²]) from the nationwide Italian Network-Heart Failure (IN-HF) registry.

Intervención

KDIGO stage 4-5 CKD (eGFR <30 ml/min/1.73 m²)

Comparador

KDIGO stage 3b CKD (eGFR 30-44 ml/min/1.73 m²)

Resultado

Major adverse cardiovascular (CV) events (MACE) and CV death or heart failure hospitalization (CVd-HFH)composite

In heart failure outpatients with moderate-to-severe CKD, those with stage 4-5 have a significantly higher risk of MACE than those with stage 3b, and despite increased contemporary use of beta-blockers and MRAs, overall prognosis has not improved over time.

Resumen

BACKGROUND Chronic kidney disease (CKD) commonly coexists with heart failure (HF), negatively impacting prognosis. We analyzed temporal trends in clinical characteristics, HF medications use and outcomes in outpatients with chronic HF and CKD, KDIGO stage 3b and stages 4-5, in a nationwide HF registry. METHODS We retrospectively analyzed patients stratified by CKD levels (3b: eGFR 30-44; 4-5: eGFR <30 ml/min/1.73 m²) and enrolment period (2007-2016 vs 2017-2023) Outcomes were major adverse cardiovascular (CV) events (MACE) and CV death or heart failure hospitalization (CVd-HFH). RESULTS Among 2003 patients, 1450 (72.4%) had stage 3b and 553 (27.6%) stage 4-5 CKD. HF drugs prescription rates were 73.7% for renin-angiotensin system inhibitors/angiotensin receptor-neprilysin inhibitors (RASI/ARNI) (79.3% vs 59%, p<0.001), 52.7% for mineralocorticoid receptor antagonist (MRA) (56.4% vs 43%, p<0.001), 81.5% for betablockers (BB) (81.6% vs 81.4%, p=0.949), respectively. Over time, use and target-dose achievement of RASI/ARNI declined, while BB and MRA uptake increased. Among HFrEF patients 47% (stage 3b) and 31% (stage 4-5) received triple therapy (RASI/ARNI+BB+MRA). Stage 4-5 patients had a higher risk of MACE (adjHR 1.280, 95%CI 1.078-1.519, p=0.005) Outcomes did not improve over time (CKD stage*enrolment period interaction, p=0.277). CONCLUSIONS In HF outpatients with moderate-to-severe CKD, we observed higher contemporary use of BB, MRA, and triple therapy than previously reported. Prognosis did not substantially improve over time, likely due to increasing patient complexity. Integrated cardio-renal care and prospective studies to optimize treatment and improve outcomes in this population are needed.

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Cite This Study

Bianco et al. (Thu,) studied this question.

synapsesocial.com/papers/69a75d8fc6e9836116a27b84 https://doi.org/https://doi.org/10.1016/j.ejim.2026.106728

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