Progression of Renal Impairment and Chronic Kidney Disease in Chronic Heart Failure: An Analysis From GISSI-HF

Background

Data on the natural change in renal function in patients with chronic heart failure (HF) are limited.

Methods and Results

Estimated glomerular filtration rate (eGFR) was assessed over 36 months in 6934 patients included in the GISSI-HF study. Associations from baseline, changes in renal function, and occurrence of cardiovascular death or HF hospitalization were assessed. Mean age was 67 years, mainly men (78%), and mean eGFR was 68?mL???min^?1???1.73?m^?2. Change in eGFR in the 1st year was ?1.5?±?16?mL???min^?1???1.73?m^?2, and over 36 months it was ?3.7?±?18?mL???min^?1???1.73?m^?2. Over the latter period, only 25% deteriorated ≥1 Kidney Disease Outcomes Quality Initiatives (KDOQI) class of chronic kidney disease (CKD). Fifteen percent of patients had >15?mL???min^?1???1.73?m^?2 decrease in eGFR in the 1st 12 months. Lower eGFR was associated with outcome: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.08–1.10 (P?<?.001) per 10?mL???min^?1???1.73?m^?2 decrease, as well as every 10?mL???min^?1???1.73?m^?2 decrease over the 1st year (HR 1.10, 95% CI 1.04–1.17; P?<?.001). A deterioration in eGFR >15?mL???min^?1???1.73?m^?2 in the 1st year showed the highest risk of events (HR 1.22, 95% CI 1.10–1.36; P?<?.001).

Conclusions

Mean decrease in renal function over time in patients with chronic HF was modest. Only 25% deteriorated ≥1 KDOQI class of CKD after 3 years. Any decrease in eGFR over time was associated with strongly increased event rates.