In patients with chronic kidney disease, HFrEF was associated with a significantly higher risk of MACE (HR 1.17; P<0.001) and all-cause mortality compared with HFpEF.
Cohort (n=14,758)
Yes
Does the HFrEF phenotype compared to HFpEF increase the risk of adverse outcomes in patients with non-dialysis-dependent CKD?
In patients with non-dialysis-dependent CKD, concurrent HFrEF is associated with higher risks of MACE and mortality compared to HFpEF, particularly when NT-proBNP is elevated.
Effect estimate: HR 1.17
p-value: p=<0.001
OBJECTIVE: To evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) across different heart failure phenotypes in patients with chronic kidney disease (CKD). METHODS: This retrospective cohort study used data from the TriNetX Global Research Network to identify adults with non-dialysis-dependent CKD and concurrent heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF) between January 1, 2002, and December 31, 2020. Propensity score matching was applied to balance baseline characteristics. NT-proBNP and metabolic markers were analyzed, and outcomes were evaluated over a 3-year period, including all-cause mortality, major adverse cardiac events (MACE), and major adverse kidney events. RESULTS: Among 14,758 matched patients (n=7379 per group), those with HFrEF had significantly higher NT-proBNP levels and an elevated risk of all-cause mortality (HR, 1.09; P=.02) and MACE (HR, 1.17; P<.001) compared with patients with HFpEF. Major adverse kidney events incidence did not differ significantly between groups. Elevated NT-proBNP was strongly associated with adverse cardiovascular outcomes in the HFrEF subgroup. Distinct metabolic and nutritional profiles also influenced outcome trajectories. CONCLUSION: Among patients with CKD, those with HFrEF exhibited higher risks of MACE and mortality than those with HFpEF, especially in the presence of elevated NT-proBNP. Although NT-proBNP facilitates cardiovascular risk stratification, its predictive value for renal outcomes in patients with concurrent CKD and heart failure is limited.
Chen et al. (Thu,) conducted a cohort in Chronic kidney disease with concurrent heart failure (n=14,758). Heart failure with reduced ejection fraction (HFrEF) vs. Heart failure with preserved ejection fraction (HFpEF) was evaluated on Major adverse cardiac events (MACE) (HR 1.17, p=<0.001). In patients with chronic kidney disease, HFrEF was associated with a significantly higher risk of MACE (HR 1.17; P<0.001) and all-cause mortality compared with HFpEF.