Abstract 2502: Renal Dysfunction Is Associated With Increased Risk Of Fatal And Non-fatal Cardiovascular Events In Patients With Heart Failure And Preserved Ejection Fraction - Findings From The Irbesartan In Heart Failure With Preserved Systolic Function Trial (I-Preserve)
Background: Chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2, is present in about 1/3 of ambulatory patients with heart failure (HF) and reduced ejection fraction (EF) and is an independent predictor of the risk of fatal and non-fatal cardiovascular (CV) events. The prevalence of CKD and whether it is an independent predictor of CV outcomes has not been defined in a large cohort of well characterized patients with HF and preserved EF (HF-PEF).
Methods: The Irbesartan in Heart Failure with Preserved Systolic Function Trial (I-PRESERVE) randomized 4128 patients with an EF ≥ 45% to receive irbesartan or placebo and eGFR was calculated in 4052 using the simplified Modification of Diet in Renal Disease (MDRD) formula. The primary outcome of time to all-cause mortality or CV hospitalization (myocardial infarction, stroke, worsening HF, atrial or ventricular arrhythmia or unstable angina) over one year of follow-up was compared between patients according to eGFR category. The independent predictive role of eGFR was examined in a multivariable model (which included symptoms, signs, clinical history, CV examination, biochemical and hemato-logic findings) and expressed as a hazard ratio (HR) per eGFR category change.
Results: The proportion of patients with a baseline eGFR of ≥ 90, 90 – 60, 60 –30 and ≥ 30, was 17%, 52%, 29% and 1.4%, respectively i.e. 30.4% of patients had CKD; differences between CKD and no-CKD patients are shown in the table⇓. The primary end point occurred in 7%, 11%, 18% and 32% of the eGFR categories, respectively. In a multivariate analysis eGFR was a significant predictor of this endpoint with a HR of 1.33 (95%CI 1.15, 1.54) for each category difference.
Conclusions: The prevalence of CKD in HF-PEF is similar to that reported in low EF HF. HF-PEF patients with CKD have a significantly worse outcome than those without CKD and this increased risk is independent of other factors associated with a worse prognosis.