Renal Dysfunction in Heart Failure With Preserved Ejection Fraction: Insights From the RELAX Trial |
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| Institution: | 1. Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois;2. Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois;3. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota;4. Division of Cardiology, Duke University Medical Center, Durham, North Carolina;5. Division of Nephrology, San Francisco VA Medical Center/University of California, San Francisco, California;1. Center for Primary Health Care Research, Lund University, Malmö, Sweden;2. Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA;3. Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan;1. Department of Pharmacy, Brigham and Women''s Hospital, Boston, Massachusetts;2. Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee;3. Division of Cardiovascular Medicine, Brigham and Women''s Hospital, Boston, Massachusetts;1. Department of Cardiology, Fourth Affiliated Hospital of China Medical University, Shenyang 110032, Liaoning, China;2. The Second Affiliated Hospital of Shenyang Medical College, Shenyang 110036, Liaoning, China;1. University of Michigan, Ann Arbor, Michigan;2. Columbia University, New York, New York;3. Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan |
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| Abstract: | BackgroundPatients with heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD) represent a high-risk phenotype. The Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction (RELAX) trial enrolled a high proportion of CKD participants, allowing investigation into differences in HFpEF by CKD status.Methods and ResultsAmong 212 participants, we investigated the associations of CKD with biomarkers, cardiac structure, and exercise capacity, and identified predictors of change in estimated glomerular filtration rate (eGFR) over trial follow-up. CKD participants (eGFR ≤60 mL/min/1.73m2) were older, had more comorbidities, and had worse diastolic function. Lower eGFR was associated with higher levels of endothelin-1, N-terminal pro–B-type natriuretic peptide, aldosterone, uric acid, and biomarkers of fibrosis (P < .05 for all). Whereas lower eGFR was associated with worse peak oxygen consumption (VO2) after adjustment for demographics, clinical comorbidities, exercise modality, ejection fraction, and chronotropic index (β coefficient per 1 SD decrease in eGFR: −0.61, 95% CI: −1.01, −0.22, P = .002), this association was attenuated after further adjustment for hemoglobin (β coefficient: −0.26, 95% CI: −0.68, 0.16, P = .22). Hemoglobin mediated 35% of the association between eGFR and peak VO2. Sildenafil therapy was independently associated with worsening eGFR over the trial (β coefficient: −2.79, 95% CI: −5.34, −0.24, P = .03).ConclusionRenal dysfunction in HFpEF is characterized by echocardiographic and biomarker profiles indicative of more advanced disease, and reduced hemoglobin is a strong mediator of the association between renal dysfunction and low exercise capacity. Sildenafil therapy was associated with worsening of renal function in RELAX. |
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