End-stage renal disease uncommon in patients with systolic heart failure

End-stage renal disease (ESRD) is uncommon in outpatients with systolic heart failure, but certain factors can identify those at highest risk, according to a new study.

Although renal dysfunction is fairly common in patients with heart failure, it is not known how often it progresses to ESRD. Researchers used data from the Danish Heart Failure Clinics Network to determine the incidence of and identify predictors for ESRD in outpatients with systolic heart failure who were treated according to guidelines. Renal function was estimated by using the Chronic Kidney Disease Epidemiology Collaboration equation, and patients were divided according to estimated glomerular filtration rate (eGFR): group I, ≥60 mL/min/1.73 m²; group II, 30 to 59 mL/min/1.73 m²; group III, 15 to 29 mL/min/1.73 m²; and group IV, <15 mL/min/1.73 m². The researchers used Cox hazard models for time to ESRD, death and a composite end point of ESRD or death. The study results were published online Oct. 18 by Circulation: Heart Failure.

Overall, 8,204 patients were included. The median patient age was 70 years, and 28% of patients were women. The median left ventricular ejection fraction was 30%; median eGFR was 68 mL/min/1.73 m². Over a median follow-up of 3.7 years, 41 patients (1.2 per 1,000 patient-years) developed ESRD and 2,652 patients (84 per 1,000 patient-years) died. Time to ESRD was associated with worse baseline eGFR (groups II, III and IV; P<0.001 for all), uncontrolled hypertension (P=0.049), need for diuretics (P=0.023) and age younger than 60 years (P=0.016).

The authors noted that their results apply only to patients with systolic heart failure and mild to moderate symptoms and should not be generalized to those with more severe heart failure or those with heart failure and preserved ejection fraction. They also pointed out that the number of renal end points was small and that their study may have lacked power, among other limitations. However, they concluded that ESRD is uncommon overall in outpatients with systolic heart failure but that it is more likely in those with certain characteristics.

“Despite improved survival in systolic [heart failure], mortality risk is still a much larger clinical problem than risk of ESRD,” the authors wrote. “eGFR-group, younger age, need for diuretics and uncontrolled hypertension are important risk factors for development of ESRD.”