Incidence and Predictors of End-Stage Renal Disease in Outpatients With Systolic Heart Failure

Abstract

Background— Renal dysfunction is an important prognostic factor in heart failure (HF), but whether this dysfunction progresses to end-stage renal disease (ESRD) is unknown. Therefore, we examined incidence and predictors of ESRD in outpatients with HF. Methods and Results— Patients with systolic HF were identified in The Danish Heart Failure database and new-onset ESRD from the Danish Registry on Dialysis. Renal function was estimated by The Chronic Kidney Disease Epidemiology Collaboration equation and patients grouped by estimated glomerular filtration rate (eGFR)—group I: ≥60 mL/min per 1.73 m 2 , group II: 30 to 59 mL/min per 1.73 m 2 , group III: 15 to 29 mL/min per 1.73 m 2 , group IV: <15 mL/min per 1.73 m 2 . Cox hazard models for time to ESRD, to death, and the composite end point of ESRD or death were constructed and predictors of ESRD identified. A total of 8204 patients were included in the analyses. Median age was 70 years (Q, 61–77), 28% were women, median left ventricular ejection fraction was 30% (Q, 24–40), and median eGFR was 68 (Q, 51–85) mL/min per 1.73 m 2 . Forty-one patients developed ESRD (1.3/1000 patient-years). Baseline eGFR group II ( P <0.001), eGFR group III ( P <0.001), eGFR group IV ( P <0.001), uncontrolled hypertension ( P =0.049), need of diuretics, and age <60 years ( P =0.016) were associated with time to ESRD. Conclusions— ESRD is rare in outpatients with systolic HF and is mainly observed in patients with an eGFR <30 mL/min per 1.73 m 2 . A low eGFR, age <60 years, need of diuretics, and uncontrolled hypertension identify patients with an increased risk for ESRD.