EFFECT OF SEVERITY AND ETIOLOGY OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH HEART FAILURE WITH MILDLY REDUCED EJECTION FRACTION

HS RAMZAN; A RAWAT; G MUSTAFA; S SATTAR; A SHAHEEN; AAA ABDELGANI; N LODHI; Z RAMZAN

doi:10.54112/bcsrj.v2024i1.888

Authors

HS RAMZAN IMBB, University of Lahore, Pakistan
A RAWAT Department of Cardiology, Himalayan Institute of Medical Science, Dehradun, India
G MUSTAFA Department of Medicine, Ghurki Trust Teaching Hospital, Pakistan
S SATTAR Department of Medicine, Watim Dental and Medical College (WDMC), Pakistan
A SHAHEEN Fateh Buzdar Cardiology Centre DG Khan, Pakistan
AAA ABDELGANI Department of Cardiology, Scarborough General Hospital, Canada
N LODHI Department of Biochemistry, Al Aleem Medical College Lahore, Pakistan
Z RAMZAN Amna Inayat Medical College, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.888

Keywords:

Chronic Kidney Disease (CKD), Heart Failure with mildly reduced Ejection Fraction (HFmrEF), Diabetic Nephropathy, Hypertensive Nephrosclerosis, Mortality and Hospitalization Risk

Abstract

This study explores the impact of chronic kidney disease (CKD) severity and etiology on patients with heart failure with mildly reduced ejection fraction (HFmrEF). Understanding these relationships is crucial for optimizing management strategies and improving patient outcomes. Methods: A cross-sectional study was conducted involving 550 patients diagnosed with HFmrEF. Patients were categorized based on CKD severity (stages 1 to 5) and etiology (diabetic nephropathy, hypertensive nephrosclerosis, glomerulonephritis, and others). Data on demographics, clinical characteristics, laboratory findings, and echocardiographic parameters were collected and analyzed. Results: Data were collected from 550 patients according to the study's criteria. The mean age of the patients was 62.5 ± 10.8 years. Of 550, 320 (58.2%) were male, and 230 (41.8%) were female. According to the NYHA classification, 40 (7.3%) belong to Class I, 290 (52.7%) to Class II, 200 (36.4%) to Class III, and 20 (3.6%) to Class IV. Advanced CKD stage (OR 2.5, 95% CI 1.6-3.8), diabetic nephropathy (OR 1.8, 95% CI 1.1-3.0), and lower eGFR (OR 2.2, 95% CI 1.5-3.2) were all associated with increased risk of mortality and hospitalizations. Conclusions: It is concluded that the severity and etiology of chronic kidney disease significantly impact the outcomes of patients with heart failure with mildly reduced ejection fraction. Advanced CKD stages and diabetic nephropathy are associated with higher mortality rates and more frequent hospitalizations.

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References

Bansal N, Zelnick LR, Scherzer R, Estrella M, Shlipak MG. Risk Factors and Outcomes Associated With Heart Failure With Preserved and Reduced Ejection Fraction in People With Chronic Kidney Disease. Circulation: Heart Failure. 2024:e011173.

Beldhuis IE, Lam CS, Testani JM, Voors AA, Van Spall HG, Ter Maaten JM, et al. Evidence-based medical therapy in patients with heart failure with reduced ejection fraction and chronic kidney disease. Circulation. 2022;145(9):693-712.

Fu EL, Uijl A, Dekker FW, Lund LH, Savarese G, Carrero JJ. Association between β-blocker use and mortality/morbidity in patients with heart failure with reduced, midrange, and preserved ejection fraction and advanced chronic kidney disease. Circulation: Heart Failure. 2020;13(11):e007180.

Mark PB, Mangion K, Rankin AJ, Rutherford E, Lang NN, Petrie MC, et al. Left ventricular dysfunction with preserved ejection fraction: the most common left ventricular disorder in chronic kidney disease patients. Clinical Kidney Journal. 2022;15(12):2186-99.

Voors AA, Mulder H, Reyes E, Cowie MR, Lassus J, Hernandez AF, et al. Renal function and the effects of vericiguat in patients with worsening heart failure with reduced ejection fraction: insights from the VICTORIA (Vericiguat Global Study in Subjects with HFrEF) trial. European Journal of Heart Failure. 2021;23(8):1313-21.

Schupp T, Bertsch T, Reinhardt M, Abel N, Schmitt A, Lau F, et al. Effect of heart failure pharmacotherapies in patients with heart failure with mildly reduced ejection fraction. European Journal of Preventive Cardiology. 2024:zwae121.

Hsiao F-C, Lin C-P, Yu C-C, Tung Y-C, Chu P-H. Angiotensin receptor-neprilysin inhibitors in patients with heart failure with reduced ejection fraction and advanced chronic kidney disease: a retrospective multi-institutional study. Frontiers in Cardiovascular Medicine. 2022;9:794707.

Savarese G, Stolfo D, Sinagra G, Lund LH. Heart failure with mid-range or mildly reduced ejection fraction. Nature Reviews Cardiology. 2022;19(2):100-16.

Piepoli MF, Salvioni E, Corrà U, Doni F, Bonomi A, La Gioia R, et al. Increased serum uric acid level predicts poor prognosis in mildly severe chronic heart failure with reduced ejection fraction. An analysis from the MECKI score research group. European journal of internal medicine. 2020;72:47-52.

Bajaj NS, Singh A, Zhou W, Gupta A, Fujikura K, Byrne C, et al. Coronary microvascular dysfunction, left ventricular remodeling, and clinical outcomes in patients with chronic kidney impairment. Circulation. 2020;141(1):21-33.

Murphy SP, Ibrahim NE, Januzzi JL. Heart failure with reduced ejection fraction: a review. Jama. 2020;324(5):488-504.

Bhinder J, Patibandla S, Gupta CA, Levine A, Gass AL, Lanier GM. Mineralocorticoid receptor antagonist use in heart failure with reduced ejection fraction and end-stage renal disease patients on dialysis: a literature review. Cardiology in Review. 2020;28(3):107-15.

Kaplon-Cieslicka A, Benson L, Chioncel O, Crespo-Leiro M, Coats A, Anker S. Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the ESC Heart Failure Long-Term Registry Investigators. A comprehensive characterization of acute heart failure with preserved versus mildly reduced versus reduced ejection fraction–insights from the ESC-HFA EORP Heart Failure Long-Term Registry. Eur J Heart Fail. 2022;24:335-50.

Yeoh SE, Dewan P, Serenelli M, Ferreira JP, Pitt B, Swedberg K, et al. Effects of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction patients with chronic obstructive pulmonary disease in EMPHASIS‐HF and RALES. European Journal of Heart Failure. 2022;24(3):529-38.

Mewton N, Girerd N, Boffa J-J, Courivaud C, Isnard R, Juillard L, et al. Practical management of worsening renal function in outpatients with heart failure and reduced ejection fraction: Statement from a panel of multidisciplinary experts and the Heart Failure Working Group of the French Society of Cardiology. Archives of cardiovascular diseases. 2020;113(10):660-70.

Joslin JR, Lioudaki E, Androulakis E. Interrelation between heart failure with preserved ejection fraction and renal impairment. Reviews in cardiovascular medicine. 2022;23(2):69.

Berliner D, Hänselmann A, Bauersachs J. The treatment of heart failure with reduced ejection fraction. Deutsches Ärzteblatt International. 2020;117(21):376.

Haydock PM, Flett AS. Management of heart failure with reduced ejection fraction. Heart. 2022;108(19):1571-9.

Guaricci AI, Sturdà F, Russo R, Basile P, Baggiano A, Mushtaq S, et al. Assessment and management of heart failure in patients with chronic kidney disease. Heart Failure Reviews. 2024;29(2):379-94.

McCallum W, Tighiouart H, Ku E, Salem D, Sarnak MJ. Trends in kidney function outcomes following RAAS inhibition in patients with heart failure with reduced ejection fraction. American Journal of Kidney Diseases. 2020;75(1):21-9.