Outcomes of KDIGO-Defined CKD in U.S. Veterans With HFpEF, HFmrEF, and HFrEF

Authors

Samir Patel, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA.
Venkatesh K. Raman, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, Georgetown University, Washington, District of Columbia, USA.
Charles Faselis, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA; Department of Medicine, Uniformed Services University, Washington, District of Columbia, USA.
Gregg C. Fonarow, Department of Medicine, University of California, Los Angeles, California, USA. Electronic address: https://twitter.com/gcfmd.
Phillip H. Lam, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, Georgetown University, Washington, District of Columbia, USA; Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA. Electronic address: https://twitter.com/PhilLamMD.
Amiya A. Ahmed, Department of Medicine, Yale University, New Haven, Connecticut, USA.
Paul A. Heidenreich, Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA; Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Stefan D. Anker, Department of Cardiology of German Heart Center Charité; German Centre for Cardiovascular Research partner site Berlin, Charité Universitätsmedizin, Berlin, Germany; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Prakash Deedwania, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, University of California, San Francisco, California, USA.
Charity J. Morgan, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Sijian Zhang, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA.
Hans Moore, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA; Department of Medicine, Georgetown University, Washington, District of Columbia, USA; Department of Medicine, Uniformed Services University, Washington, District of Columbia, USA.
Janani Rangaswami, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA. Electronic address: https://twitter.com/RangaswJ.
George Bakris, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
Javed Butler, Baylor Scott and White Research Institute, Dallas, Texas, USA; Department of Medicine, University of Mississippi, Jackson, Mississippi, USA. Electronic address: https://twitter.com/JavedButler1.
Helen M. Sheriff, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA.
Richard M. Allman, Department of Medicine, George Washington University, Washington, District of Columbia, USA; Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.
Qing Zeng-Treitler, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA.
Wen-Chih Wu, Department of Medicine, Veterans Affairs Medical Center, Providence, Rhode Island, USA; Department of Medicine, Brown University, Providence, Rhode Island, USA.
Ali Ahmed, Department of Medicine, Veterans Affairs Medical Center, Washington, District of Columbia, USA; Department of Medicine, George Washington University, Washington, District of Columbia, USA; Department of Medicine, Georgetown University, Washington, District of Columbia, USA. Electronic address: ali.ahmed@va.gov.

Document Type

Journal Article

Publication Date

3-1-2025

Journal

JACC. Heart failure

Volume

13

Issue

3

DOI

10.1016/j.jchf.2024.11.007

Keywords

KDIGO (Kidney Disease: Improving Global Outcomes); chronic kidney disease; ejection fraction; heart failure; outcomes

Abstract

BACKGROUND: Chronic kidney disease (CKD) is defined by the KDIGO (Kidney Disease: Improving Global Outcomes) guideline as abnormal kidney structure or function, present for >3 months, with implications for health. KDIGO-defined CKD is associated with poor outcomes in patients with heart failure (HF). Less is known about whether these associations vary by left ventricular ejection fraction. OBJECTIVES: This study aims to determine the prevalence and outcomes of KDIGO-defined CKD in heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF). METHODS: Of the 1,446,053 veterans with an HF diagnosis (1991-2017) in the national Veterans Affairs electronic health record data, 365,000 with data on EF had KDIGO-defined CKD or normal kidney function (NKF). CKD was defined as 2 values measured 90 days apart of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m (categorized into 4 eGFR stages based on the last eGFR: 45-59 mL/min/1.73 m, 30-44 mL/min/1.73 m, 15-29 mL/min/1.73 m, and <15 mL/min/1.73 m) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (albuminuria). NKF was defined as 2 values measured >90 days apart of eGFR ≥60 mL/min/1.73 m, without eGFR <60 mL/min/1.73 m or albuminuria for 3 years before HF diagnosis. Patients were categorized into HFpEF (EF ≥50%, n = 85,855), HFmrEF (EF 41%-49%, n = 39,397), and HFrEF (EF ≤40%, n = 139,748). HRs and 95% CIs for 5-year all-cause mortality and HF hospitalization through December 31, 2022, associated with the 5 CKD groups (vs NKF) were estimated using Cox regression. RESULTS: Among patients with HF and NKF, mortality occurred in 39%, 37%. and 41%, and HF hospitalization occurred in 12%, 15%, and 21% of those with HFpEF, HFmrEF. and HFrEF, respectively. Compared with NKF, CKD was associated with 16%, 19%, and 26% higher multivariable-adjusted risks for death in patients with HFpEF, HFmrEF, and HFrEF, respectively. Respective risks for HF hospitalization were 31%, 33%, and 32% higher. The eGFR-associated risks were incrementally higher with decreasing eGFR, except for eGFR <15 mL/min/1.73 m, likely because of the initiation of dialysis during follow-up. Albuminuria was associated with 16%, 10%, and 12% higher multivariable-adjusted risks for death and 29, 30%, and 24% for HF hospitalization in HFpEF, HFmrEF, and HFrEF, respectively. All associations were statistically significant. CONCLUSIONS: These findings based on KDIGO-defined CKD and NKF provide new information about the best estimates of true prevalence and outcomes of CKD in HFpEF, HFmrEF, and HFrEF.

APA Citation

Patel, Samir; Raman, Venkatesh K.; Faselis, Charles; Fonarow, Gregg C.; Lam, Phillip H.; Ahmed, Amiya A.; Heidenreich, Paul A.; Anker, Stefan D.; Deedwania, Prakash; Morgan, Charity J.; Zhang, Sijian; Moore, Hans; Rangaswami, Janani; Bakris, George; Butler, Javed; Sheriff, Helen M.; Allman, Richard M.; Zeng-Treitler, Qing; Wu, Wen-Chih; and Ahmed, Ali, "Outcomes of KDIGO-Defined CKD in U.S. Veterans With HFpEF, HFmrEF, and HFrEF" (2025). GW Authored Works. Paper 6908.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6908

Department

Medicine