Abstract: TH-PO483
CKD Increases Risk for HFpEF Admission Independent of Cardiac Function
Session Information
- CKD: Epidemiology, Outcomes - Cardiovascular - I
November 02, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Chronic Kidney Disease (Non-Dialysis)
- 303 CKD: Epidemiology, Outcomes - Cardiovascular
Authors
- Mavrakanas, Thomas, Brigham and Women's Hospital, Boston, United States
- Khattak, Aisha, University of Texas Health Science Center of Huston, Houston, Texas, United States
- Wang, Wei, Brigham & Women's Hospital, Boston, Massachusetts, United States
- Singh, Karandeep, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Charytan, David M., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
Chronic kidney disease (CKD) is common among patients with heart failure with preserved ejection fraction (HFpEF) and is associated with worse clinical outcomes. Whether the association of CKD with HFpEF is independent of underlying echocardiographic abnormalities is uncertain.
Methods
This retrospective cohort study included adult patients without prevalent heart failure referred for echocardiography. Patients with serial echocardiograms, left ventricular ejection fraction (LVEF) ≥50% on baseline echocardiogram and estimated glomerular filtration rate (eGFR) ≥90 ml/min/1.73m2 were matched 1:1 with patients with eGFR<60 for age (±5 years), sex, history of hypertension or diabetes, use of renin-angiotensin inhibitors, and LVEF (±5%). A secondary analysis included patients with preserved LVEF and normal left ventricular mass index matched for the same parameters except for use of renin-angiotensin inhibitors.
Results
Among 685 matched pairs, those with CKD had higher prevalence of coronary disease and higher left atrial diameter compared with controls, as well as biochemical abnormalities associated with CKD. 256 admissions for HFpEF were observed. Patients with CKD were at increased risk for HFpEF admission: crude hazard ratio (HR) 1.79 [95% CI (confidence interval) 1.38-2.33, p<0.001] and adjusted HR (for coronary disease and left atrial diameter) 1.66 (95% CI 1.23-2.24, p=0.001). LVEF and left ventricular diameter decreased over time in both groups (p<0.001 and p<0.001 respectively) but no difference was observed in rate of dropping (p=0.39 and p=0.83 respectively). Results were similar in the secondary analysis that included 289 pairs with preserved LVEF and normal left ventricular mass index (crude HR 1.99, 95% CI 1.07-3.71, p=0.03 and HR adjusted for left atrial diameter 1.98, 95% CI 1.05-3.75, p=0.04). Rate of change was similar for LVEF, pulmonary artery pressure, and left ventricular mass index in both groups (p=0.80, p=0.38, and p=0.63 respectively).
Conclusion
The increased risk of HFpEF admission in CKD is independent of baseline cardiac function and occurs despite a similar change in relevant echocardiographic parameters over time in patients with or without CKD.
Funding
- NIDDK Support