Heart failure and advanced chronic kidney disease: differences in characteristics, treatment and outcomes in patients with glomerular filtration rate greater or less than 30 ml/minute/m2
Authors: Recio Mayoral A , Anguita Gamez M , Gonzalez Manzanares R , Bonilla Palomas J L , Romero Rodriguez N , Muniz Garcia J , Cequier Fillat A , Elola Somoza F J , Rodriguez Padial L , Anguita Sanchez M 
Published: October 2024

Abstract

Introduction
Heart failure (HF) is a serious health problem and continues to have a high mortality and incidence of decompensation, despite advances in its management. Chronic kidney disease (CKD) is very prevalent in patients with HF, hinders their treatment and worsens their prognosis, especially when it is advanced CKD (glomerular filtration rate-GFR &lt;30 ml(min/m2). It is important to know the differential characteristics of these patients to improve their management.

Purpose
To analyze in a contemporary registry of HF patients followed in specialized HF units in Spain the differences in clinical characteristics and treatment between patients with HF and advanced CKD.

Methods
We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 1716 patients with HF included between 2019 and 2021 by 45 specialized HF units accredited by the SEC. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. The clinical and demographic characteristics and comorbidities of the patients were compared according to GFR &lt; or &gt; 30ml/min/m2.

Results
Of the 1,716 patients, 11.1% had a GFR&lt;30 and 88.9% &gt;30 mL/min/m2. Figure 1 shows the main clinical characteristics and comorbidities of the 2 groups. Median LVEF was similar in both groups: 42 (30-58) vs 38% (29-54). The group with advanced CKD was older (77±9.6 vs 70.5±12.6 years; p&lt;0.001), had greater HF severity (more admissions for HF in the last year, worse NYHA functional class and longer evolution time), and a higher prevalence of coronary heart disease, hypertension, diabetes mellitus, cognitive impairment, anemia, iron deficiency and hyponatremia. There were no differences in sex, BMI, serum potassium or other comorbidities (Figure 1). Figure 2 shows the treatment received in each group. Patients with GFR &lt;30 received in a significantly lower proportion all drugs for HF (p&lt;0.001), except diuretics and potassium binders (ACEI/ARA, sacubitril-valsartan, MRA, beta-blockers, digoxin and SLGT2 inhibitors), and less cardiac rehabilitation (5.2 vs 10.4%; p=0.029). Incidence of one-year mortality was significantly higher in patients with GFR&lt;30 ml/min/m2 (37.2 vs 14.4 per 100 persons-year, p&lt;0.001), as were HF hospitalizations (61.3 vs 33.0; p&lt;0.001) and HF decompensations without hospitalization (24.1 vs 11; p&lt;0.001).

Conclusions
In our contemporary cohort of real-life HF patients, the prevalence of advanced CKD was 11.1%. These patients had a higher severity of HF, despite which, the utilization of HF drugs, including SGLT2 inhibitors was much lower than in those with GFR &gt;30 ml/min/m2. One-year mortality, HF hospitalization and HF decompensations were almost 3-times higher. This treatment trend needs to be modified to improve the prognosis of these patients.