Stabilisation or improvement of renal function (eGFR ≥45 mL/min/1.73 m2) during follow-up reduced total mortality by 57% (HR 0.43) and combined mortality and HF readmissions by 54% (HR 0.46) in patients with ‘de novo’ HFrEF.
Cohort (n=306)
Yes
Does renal function stabilisation or improvement during follow-up improve outcomes in patients with 'de novo' HFrEF?
In patients with 'de novo' HFrEF, stabilisation or improvement of renal function (eGFR ≥45 mL/min/1.73 m2) during follow-up is associated with a significantly lower risk of mortality and heart failure readmissions.
Effect estimate: HR 0.43 for total mortality (95% CI 0.20 to 0.91); HR 0.46 for combined mortality and HF readmission (p=0.014) after multivariate adjustment for patients with eGFR ≥45 at follow-up (95% CI 0.20-0.91 (mortality))
p-value: p=0.048 (mortality), 0.014 (combined)
Aims Heart failure (HF) often coexists with chronic kidney disease (CKD), impacting prognosis. This study aims to evaluate renal function trajectories and their impact on major clinical outcomes in a cohort of patients hospitalised for ‘de novo’ HF with reduced ejection fraction (HFrEF). Methods This is a prospective cohort study that included patients hospitalised for ‘de novo’ HFrEF at two university hospitals. Renal function was assessed using the CKD-Epidemiology Collaboration formula. Total mortality and the combined total mortality and HF readmissions were evaluated during follow-up. Results Of 370 patients, 306 were eligible. At discharge, 24.6% had estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m 2 . Higher eGFR at discharge was associated with better outcomes. During follow-up, 79.1% showed eGFR ≥45 mL/min/1.73 m 2 . Patients with stable or improved eGFR had lower total mortality and HF readmission rates. Factors associated with renal function improvement or stabilisation included less prior CKD, hypertension and younger age, higher eGFR values at discharge and more use of quadruple therapy at the end of uptitration period. Conclusions In patients with ‘de novo’ HFrEF, renal function deterioration at discharge correlated with poorer outcomes. However, stabilisation or improvement during follow-up was linked to better prognosis. Routine renal function assessment is crucial in HFrEF management, guiding personalised treatment strategies to mitigate renal function decline and improve patient care.
Garcia et al. (Thu,) conducted a cohort in Patients hospitalized for ‘de novo’ heart failure with reduced ejection fraction (LVEF <40%) after first hospitalization for worsening heart failure (n=306). Stabilisation or improvement of renal function (eGFR ≥45 mL/min/1.73 m2) during follow-up with use of quadruple therapy vs. Deterioration of renal function (eGFR <45 mL/min/1.73 m2) during follow-up was evaluated on Total mortality and combined total mortality and heart failure readmissions (HR 0.43 for total mortality (95% CI 0.20 to 0.91); HR 0.46 for combined mortality and HF readmission (p=0.014) after multivariate adjustment for patients with eGFR ≥45 at follow-up, 95% CI 0.20-0.91 (mortality), p=0.048 (mortality), 0.014 (combined)). Stabilisation or improvement of renal function (eGFR ≥45 mL/min/1.73 m2) during follow-up reduced total mortality by 57% (HR 0.43) and combined mortality and HF readmissions by 54% (HR 0.46) in patients with ‘de novo’ HFrEF.