Kidney Week

Abstract: SA-PO0480

Chronotropic Incompetence Is Associated with Functional Capacity Decline, Poor Quality of Life, and Mortality in Patients with CKD and Heart Failure with Reduced Ejection Fraction

Session Information

• CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered 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

• Campos, Monique Opuszcka, Indiana University School of Medicine, Indianapolis, Indiana, United States

Monique Opuszcka Campos, PhD

• Narayanan, Gayatri, Indiana University School of Medicine, Indianapolis, Indiana, United States

Gayatri Narayanan, MS

• Burney, Heather, Indiana University School of Medicine, Indianapolis, Indiana, United States

Heather Burney, MS

• Sun, Chien Yao, Indiana University School of Medicine, Indianapolis, Indiana, United States

Chien Yao Sun, MD, MS, MSc

• Lim, Kenneth, Indiana University School of Medicine, Indianapolis, Indiana, United States

Kenneth Lim, MD, PhD, FASN

Background

Chronotropic incompetence (CI), defined as an inadequate heart rate response to exercise, is a major complication underlying impaired functional capacity in patients with heart failure(HF). CI strongly predicts adverse outcomes, but its clinical implications in chronic kidney disease (CKD) remain incompletely understood. We evaluated the role of CI, including its association with functional capacity, quality of life (QoL), and mortality in CKD patients with heart failure with reduced ejection fraction (HFrEF).

Methods

Using HF-ACTION research materials from the NHLBI, we performed a post-hoc analysis of 1,514 patients with HFrEF. All participants underwent cardiopulmonary exercise testing, echocardiography, six-minute walk distance (6MWD), and QoL (Kansas City Cardiomyopathy Questionnaire) assessment. All-cause mortality over 4 years was the primary endpoint. Participants were stratified by CKD and CI status (<0.80 without β-blockers; <0.62 with β-blockers).

Results

Of the 1,514 patients, 588 had CKD (439 with CI, 149 without), and 926 did not have CKD (549 with CI, 377 without). Patients with CKD were older (64.4 vs 54.6 years, P<0.001), while median eGFR values were similar among CKD patients with and without CI (46.3 vs 47.4 mL/min/1.73 m², P=0.37). Left ventricular ejection fraction(LVEF) (25.2%) was similar across groups. CKD and CI group had the lowest 6MWD (341 ± 99 m) and QoL (58 [42–83]) (P<0.001). Significantly, the CKD and CI group exhibited the greatest VO₂Peak (13.0 ± 3.7) impairment compared with CKD without CI (15.7 ± 4.6), no CKD with CI (15.1 ± 4.3), and no CKD without CI (18.2 ± 4.8 mL/kg/min; P<0.001). Higher CI was associated with higher VO₂Peak (β=0.8) as well as longer 6MWD (β=10.5), and higher QoL (β=1.6; all P<0.001), adjusted for age, sex, CPET modality, diabetes, and LVEF. CKD patients with CI had the lowest survival, while non-CKD patients without CI had the highest (P<0.0001) on Kaplan-Meier. In adjusted analyses, each 0.1 increase in chronotropic index was associated with lower mortality risk overall (~18%), in CKD patients (~14%), and in non-CKD patients (~21%) (all P<0.05).

Conclusion

CI is a major determinant of impaired functional capacity, and is strongly predictive of quality of life, and mortality in HFrEF patients with CKD. CI may play a role in refining risk stratification and guiding targeted management.

Funding

• Other NIH Support