Kidney Week

Abstract: SA-PO0395

2022 American Heart Association/American College of Cardiology Heart Failure Stages and Incident Heart Failure Risk in CKD

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Krishnan, Vaishnavi, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States

Vaishnavi Krishnan

• Cai, Xuan, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Xuan Cai

• Rincon-Choles, Hernan, Cleveland Clinic, Cleveland, Ohio, United States

Hernan Rincon-Choles, MD, MS, MBA, FASN

• Rao, Panduranga S., University of Michigan Medical School, Ann Arbor, Michigan, United States

Panduranga S. Rao, MD, MBBS, MS

• He, Jiang, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Jiang He, MD, PhD

• Chen, Jing, The University of Texas Southwestern Medical Center, Dallas, Texas, United States

Jing Chen, MD, MS, MSc, FASN

• Lash, James P., University of Illinois Chicago College of Medicine, Chicago, Illinois, United States

James P. Lash, MD, FASN

• Khan, Sadiya, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Sadiya Khan, MD, MSc

• Mehta, Rupal, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

Rupal Mehta, MD, MS, FASN

Background

Individuals with chronic kidney disease (CKD) are at high risk for heart failure (HF), but prevalence of Stage A (at risk) and Stage B (pre-heart failure [HF]) based on the latest universal definition of HF is understudied in this population.

Methods

In Chronic Renal Insufficiency Cohort (CRIC) participants without prior HF history, we applied the 2022 American Heart Association/American College of Cardiology HF staging criteria at baseline to define Stage A (≥1 traditional risk factor) and Stage B (evidence of structural heart disease on echocardiography or elevated B-type natriuretic peptide). We assessed incident HF risk in adjusted Cox models.

Results

Among 2250 CRIC participants (mean [SD] age 58.5 years [10.9], eGFR: 43.5 ml/min/1.73m² [16.3]), 1.4% did not have any traditional risk factors, 23.4% were in Stage A, and 75.2% were in Stage B. The prevalence of Stage B was higher in those with lower kidney function (Figure A).

Over a median follow-up of 11.5 years, 434 HF events occurred. Of those who developed an HF event, median time to HF event was 7.5 years for Stage A versus 5.7 years for Stage B participants. Compared to Stage A, participants in Stage B had a 2.5-times higher risk for incident HF after full adjustment for cardiovascular and renal risk factors, with similar levels of risk for developing HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) (Figure B).

Conclusion

Stage B HF is highly prevalent among individuals with CKD and is associated with increased risk of incident HF, with similar magnitude of risk of HFpEF and HFrEF. Consideration of CKD as a Stage B ("pre-HF") equivalent should be evaluated.

Funding

• NIDDK Support