Revista espanola de cardiologia (English ed.) · 2026
Prognostic impact of kidney function in a large contemporary ambulatory heart failure cohort.
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Cobo Marcos Marta, de la Espriella Rafael, Gayán Ordás Jara, Llàcer Pau, Zegrí-Reiriz Isabel, Fort Aleix, Ponz de Antonio Inés, Méndez Ana, Blázquez-Bermejo Zorba, Caravaca Pérez Pedro, Rubio Gracia Jorge, Recio-Mayoral Alejandro, García Pinilla José Manuel, Montero Hernández Esther, Castro Almudena, Soler María José, Górriz José Luis, Bascompte Claret Ramón, Fluvià-Brugués Paula, Manzano Luis, Núñez Julio
Аннотация
INTRODUCTION AND OBJECTIVES: Kidney dysfunction is common in chronic heart failure (CHF), but its prognostic significance in contemporary populations remains uncertain. We evaluated 1-year outcomes according to kidney function stage and the prognostic role of the estimated glomerular filtration rate (eGFR).
METHODS: We analyzed 1105 patients with CHF enrolled in the CARDIOREN Registry (13 centers, 2021-2022). Kidney function was categorized according to CKD-EPI eGFR (≥ 60, 30-59,<30mL/min/1.73 m2). The primary endpoint was the composite of all-cause death or worsening heart failure at 1 year; all-cause mortality was analyzed separately. Associations were assessed using multivariable Cox regression models with fractional polynomial modeling.
RESULTS: Median age was 75 years, 63% of patients were men, and 38% had heart failure with preserved ejection fraction. Overall, 59% had eGFR <60mL/min/1.73 m2. At 1 year, the composite endpoint occurred in 24% of patients, and all-cause mortality occurred in 13%. Event rates increased progressively with worsening kidney function categories for the primary endpoint (11%, 31%, and 38%; P <.001) and for all-cause mortality (4%, 16%, and 26%; P <.001). In multivariable analysis, N-terminal pro-B-type natriuretic peptide, hemoglobin, and furosemide-equivalent dose were independently associated with both outcomes. Hemoglobin showed a U-shaped association, with higher risk at both low and high concentrations. CA125 was independently associated with all-cause mortality. eGFR was not independently associated with the composite endpoint but remained independently associated with all-cause mortality, showing a nonlinear inverse relationship.
CONCLUSIONS: In this contemporary CHF population, worse kidney function identified patients with a more adverse clinical profile and poorer outcomes, although these associations were attenuated after adjustment for congestion markers and disease severity.
METHODS: We analyzed 1105 patients with CHF enrolled in the CARDIOREN Registry (13 centers, 2021-2022). Kidney function was categorized according to CKD-EPI eGFR (≥ 60, 30-59,<30mL/min/1.73 m2). The primary endpoint was the composite of all-cause death or worsening heart failure at 1 year; all-cause mortality was analyzed separately. Associations were assessed using multivariable Cox regression models with fractional polynomial modeling.
RESULTS: Median age was 75 years, 63% of patients were men, and 38% had heart failure with preserved ejection fraction. Overall, 59% had eGFR <60mL/min/1.73 m2. At 1 year, the composite endpoint occurred in 24% of patients, and all-cause mortality occurred in 13%. Event rates increased progressively with worsening kidney function categories for the primary endpoint (11%, 31%, and 38%; P <.001) and for all-cause mortality (4%, 16%, and 26%; P <.001). In multivariable analysis, N-terminal pro-B-type natriuretic peptide, hemoglobin, and furosemide-equivalent dose were independently associated with both outcomes. Hemoglobin showed a U-shaped association, with higher risk at both low and high concentrations. CA125 was independently associated with all-cause mortality. eGFR was not independently associated with the composite endpoint but remained independently associated with all-cause mortality, showing a nonlinear inverse relationship.
CONCLUSIONS: In this contemporary CHF population, worse kidney function identified patients with a more adverse clinical profile and poorer outcomes, although these associations were attenuated after adjustment for congestion markers and disease severity.