Influence of chronic kidney disease on patients with heart failure outcome

Abstract

Patients with heart failure and renal impairment have poor outcomes and variable quality of care. The present study aimed to evaluate whether chronic kidney disease (CKD) could have adverse effects on mortality, morbidity rates and optimal treatment prescription in patients with a diagnosis of heart failure. This is an ancillary analysis of the prospective NATURE HF registry (NAtional TUnisian REgistry of Heart Failure). Between October 2017 and January 2018, we prospectively registered information of patients with heart failure and followed them for one year. We registered information of 2040 patients with heart failure. Prevalence of CKD (eGFR < 60 ml/min/1.73m 2 ) in the HF community was 23.5%. There were 19.9% patients in Stage 3a/b (cl 59–30 mL/min) and 3.6% in Stage 4/5 (cl< 30 ml/min). Patients with CKD were significantly older, more often diabetic, more hypertensive, and have lower hemoglobin, but similar prevalence of left ventricular systolic dysfunction compared with patients in Stages 0-2. CKD patients’ have more re-hospitalizations and mortality rates compared to those without CKD, respectively 12% vs. 5,8% ( P = 0,001) and 16% vs. 12% ( P = 0,003). The prescription of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was more important in CKD patients’ (72% vs. 67,5%, P < 0,001). The anti-aldosterone's prescription decreased with progressive CKD ( P < 0,001). There was no difference in ICD implantation rates between the two groups. Patients with heart failure and chronic renal impairment had poor outcomes but received recommended therapy as patients without CKD. This study highlights the need for multidisciplinary approach and better evidence for treatment, to improve morbidity and mortality.