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Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study
University of Massachusetts Medical School Faculty Publications
  • David H. Smith, Kaiser Permanente
  • Micah L. Thorp, Kaiser Permanente
  • Jerry H. Gurwitz, University of Massachusetts Medical School
  • David D. McManus, University of Massachusetts Medical School Worcester
  • Robert J. Goldberg, University of Massachusetts Medical School
  • Larry A. Allen, University of Colorado at Denver and Health Sciences Center
  • Grace Hsu, Kaiser Permanente
  • Sue Hee Sung, Kaiser Permanente
  • David J. Magid, Kaiser Permanente
  • Alan S. Go, Kaiser Permanente
UMMS Affiliation
Meyers Primary Care Institute; Department of Medicine, Divisions of Geriatric Medicine and Cardiovascular Medicine; Department of Quantitative Health Sciences
Publication Date
5-17-2013
Document Type
Article
Abstract
BACKGROUND: There is scant evidence on the effect that chronic kidney disease (CKD) confers on clinically meaningful outcomes among patients with heart failure with preserved left ventricular ejection fraction (HF-PEF). METHODS AND RESULTS: We identified a community-based cohort of patients with HF. Electronic medical record data were used to divide into HF-PEF and reduced left ventricular EF on the basis of quantitative and qualitative estimates. Level of CKD was assessed by estimated glomerular filtration rate (eGFR) and by dipstick proteinuria. We followed patients for a median of 22.1 months for outcomes of death and hospitalization (HF-specific and all-cause). Multivariable Cox regression estimated the adjusted relative-risk of outcomes by level of CKD, separately for HF-PEF and HF with reduced left ventricular EF. We identified 14 579 patients with HF-PEF and 9762 with HF with reduced left ventricular EF. When compared with patients with eGFR between 60 and 89 mL/min per 1.73 m(2), lower eGFR was associated with an independent graded increased risk of death and hospitalization. For example, among patients with HF-PEF, the risk of death was nearly double for eGFR 15 to 29 mL/min per 1.73 m(2) and 7x higher for eGFR/min per 1.73 m(2), with similar findings in those with HF with reduced left ventricular EF. CONCLUSIONS: CKD is common and an important independent predictor of death and hospitalization in adults with HF across the spectrum of left ventricular systolic function. Our study highlights the need to develop new and effective interventions for the growing number of patients with HF complicated by CKD.
Keywords
  • Chronic kidney disease,
  • Heart failure,
  • Hospitalization,
  • Mortality
Comments

Citation: Smith DH, Thorp ML, Gurwitz JH, McManus DD, Goldberg RJ, Allen LA, Hsu G, Sung SH, Magid DJ, Go AS. Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study. Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):333-42. doi:10.1161/CIRCOUTCOMES.113.000221. Link to article on publisher's site

Related Resources
Link to Article in PubMed
PubMed ID
23685625
Citation Information
David H. Smith, Micah L. Thorp, Jerry H. Gurwitz, David D. McManus, et al.. "Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study" Vol. 6 Iss. 3 (2013) ISSN: 1941-7713 (Linking)
Available at: http://works.bepress.com/robert_goldberg/384/