Key result
Severe CKD (stages 4-5, 9.9% of cohort) was associated with significantly higher 1-year mortality and HF hospitalization in HFrEF vs HFpEF, whereas no differences occurred across HF types in CKD 1-3.
Why the study?
Chronic kidney disease is prevalent in heart failure and worsens prognosis, but little is known about how CKD severity interacts with HF type (HFrEF, HFmrEF, and HFpEF) regarding drug treatment and prognosis.
Cohort (n=2,245)
Yes
In a contemporary Spanish heart failure cohort, severe renal dysfunction (CKD stages 4-5) revealed significant disparities in 1-year mortality and hospitalization rates across HF phenotypes (highest in HFrEF, lowest in HFpEF) and lower utilization of guideline-directed medical therapies.
Introduction Heart failure (HF) has a high mortality and incidence of decompensation. Chronic kidney disease (CKD) is very prevalent in patients with HF and worsens their prognosis. Few information is known about the interaction between severity of CKD and the type of HF, reduced (HFrEF), mildly reduced (HFmrEF) and preserved (HFpEF), in terms of drug treatment and prognosis, Purpose To analyze in a contemporary registry of HF patients followed in HF units in Spain the differences in clinical characteristics, treatment and 1-year outcomes between patients with HFrEF, HFmrEF and HFpEF according to CKD stage (4-5 versus 1-3). Methods We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 2,245 patients with HF included between 2019 and 2024 by 68 specialized HF units. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. Clinical characteristics, treatment and 1-year mortality and HF hospitalization rates were compared in HFrEF, HFmrEF and HFpEF patients according to CKD stages 4-5 and 1-3. Results Of the 2,245 patients, 54.2% were HFrEF, 12% HFmrEF and 33.8% HFpEF. CKD stages 4-5 were present in 9.9% (8.9% of HFrEF, 11.5% of HFmrEF and 11.3% of HFpEF patients). Median age was 73 years (IQR 63-80), being older in CKD 4-5 stages, and 37.3% were female, without differences between HF type and CKD severity. Figure 1 shows the drug treatment in all subgroups of patients. CKD 4-5 patients received in significantly lower proportion ARNI, MRA, betablockers and SGLT2i in HFrEF and HFmrEF. One-year mortality and 1-year rate of HF hospitalizations were significantly higher in patients with HFrEF and lower in those with HFpEF in cases of CKD 4-5, but there were no differences among the three types of HF in the CKD 1-3 subgroup (figure 2). Conclusions In this contemporary cohort of patients with HF, an interaction was observed between renal dysfunction and the type of HF on 1-year mortality and hospitalization rates, with significant differences in event rates between HF types only in cases of more severe renal dysfunction (CKD stages 4-5).
No takes yet. Share an insight, caveat, or question.
Gámez et al. (2026) conducted a cohort in Heart failure and chronic kidney disease (n=2,245). CKD stages 4-5 stratified by heart failure type (HFrEF, HFmrEF, HFpEF) vs. CKD stages 1-3 stratified by heart failure type was evaluated on 1-year mortality and heart failure hospitalization rates. Severe CKD (stages 4-5, 9.9% of cohort) was associated with significantly higher 1-year mortality and HF hospitalization in HFrEF vs HFpEF, whereas no differences occurred across HF types in CKD 1-3.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: