Predictors and prognostic impact of chronic kidney disease in hospitalized patients with heart failure - insights from the cardiomining study

Abstract Background/Introduction Chronic kidney disease (CKD) is a frequent comorbidity in patients with heart failure (HF). The presence of CKD is associated with more severe HF, and CKD is per se a strong independent risk factor of poor cardiovascular outcome in HF. Purpose Τo examine any risk factor differences between HF patients with and without CKD and to identify the prognostic course of each patient subgroup depending on the presence of CKD. Methods This retrospective observational study is a post-hoc analysis of the CardioMining study and includes adult patients hospitalized in multiple secondary and tertiary cardiology clinics in Greece with a history of HF. Logistic regression analyses were performed to predict the existence of comorbid CKD. Survival analyses were conducted to assess the predictors of all-cause mortality in HF patients, stratified by left ventricular ejection fraction (LVEF; HF with reduced, mid-range, and preserved ejection fraction – HFrEF, HFmrEF and HFpEF, respectively). Results A total of 10,689 HF patients (66% male) were studied (15% HFpEF, 34% HFmrEF, and 51% HFrEF). Of the total population, 13% had comorbid CKD (22% in HFpEF, 26% in HFmrEF, and 52% in HFrEF). Median age was 74 (63-82) and 79 (72-84) years in the CKD and non-CKD group, respectively. In the multivariate logistic regression model, increasing age, male gender, history of diabetes mellitus, coronary artery disease, and anemia were associated with increased risk of CKD, while administration of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) were linked with decreased risk of CKD across all HF subgroups. Additionally, atrial fibrillation was associated with increased CKD prevalence in the HFrEF and HFmrEF subgroups; peripheral artery disease and dyslipidemia were associated with increased CKD prevalence in the HFpEF subgroup, and arterial hypertension was associated with increased CKD prevalence in the HFmrEF subgroup (Figure 1). Over a median 2-year follow-up period, patients with comorbid CKD had worse prognostic course (HFpEF: aHR= 1.404 (1.145- 1.723) (95% CI), HFmrEF: aHR= 1.618 (1.333- 1.963), HFrEF: aHR= 1.539 (1.353- 1.750)) than those without CKD in every HF subgroup after adjustment for potential confounding factors (log-rank p values0.001, Figure 2). Conclusion(s) In this large real-world cohort of HF patients, CKD negatively affected HF prognosis. Diabetes mellitus and coronary artery disease were consistently linked to the development of CKD across all HF phenotypes, underscoring the importance of prevention and risk factor management. Renin-angiotensin system inhibitors played a protective role in preventing renal failure regardless of LVEF.Forest plots figure (figure 1) Kaplan-Meier figure (figure 2)