Chronic kidney disease in heart failure: results from an Ecuadorian registry

Ronald E. Pucha-Pesántez, Postgraduate Program in Cardiology, Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
Luis Moreno-Rondón, Postgraduate Program in Cardiology, Universidad de Especialidades Espíritu Santo; Cardiology Service, Hospital General del Norte de Guayaquil-Los Ceibos. Guayaquil, Ecuador
María E. Ortega-Armas, Postgraduate Program in Cardiology, Universidad de Especialidades Espíritu Santo; Cardiology Service, Hospital General del Norte de Guayaquil-Los Ceibos. Guayaquil, Ecuador
Robert Alarcón-Cedeño, Cardiology Service, Hospital General del Norte de Guayaquil-Los Ceibos. Guayaquil, Ecuador
Diego Pulla, Cardiology Service, Hospital General del Norte de Guayaquil-Los Ceibos. Guayaquil, Ecuador
Mario D. Gómez, Cardiology Service, Hospital General del Norte de Guayaquil-Los Ceibos. Guayaquil, Ecuador
Diego Villavicencio, Cardiology Service, Hospital General del Norte de Guayaquil-Los Ceibos. Guayaquil, Ecuador
Alex F. Castro-Mejía, Postgraduate Program in Cardiology, Universidad de Especialidades Espíritu Santo; Cardiology Service, Hospital General del Norte de Guayaquil-Los Ceibos. Guayaquil, Ecuador

Objectives: Heart failure (HF) frequently coexists with chronic kidney disease (CKD), a combination that is associated with worse outcomes. Data from Ecuador remain limited. We estimated the prevalence of CKD among patients with HF and described prognostic impact according to left ventricular ejection fraction (LVEF). Methods: A retrospective study was conducted using a single-center HF registry in Ecuador. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2. HF was categorized by LVEF into reduced (HF with reduced ejection fraction [HFrEF], ≤ 40%), mildly reduced (HF with mildly reduced ejection fraction [HFmrEF], 41-49%), and preserved (HF with preserved ejection fraction [HFpEF], ≥ 50%). The median follow-up was 2.28 years. Results: Among 706 patients (age 69.9 ± 13.3 years; 31.4% women), 50.3% had an eGFR ≥ 60, 33.1% had an eGFR of 30-59, and 16.6% had an eGFR < 30 mL/min/1.73m2. CKD prevalence was 57.8% in HFrEF, 41.8% in HFmrEF, and 53.5% in HFpEF (p = 0.003). CKD patients were older and had higher rates of hypertension (HT), atrial fibrillation, and cerebrovascular disease, with higher NT-proBNP levels, larger diastolic diameters, lower LVEF, more tricuspid regurgitation, and pulmonary HT (all p < 0.05). CKD was associated with increased all-cause mortality (49.3 vs. 26.8%), cardiovascular mortality (28.8 vs. 11.8%), all-cause hospitalizations (47.6 vs. 25.9%), and HF hospitalizations (22.2 vs. 11.0%). Predictors of mortality were LVEF ≤ 40% (Hazard ratio [HR] 1.5, 95% confidence interval [CI] 1.1-2.2; p = 0.048), moderate/severe tricuspid regurgitation (HR 1.6, 95% CI 1.1-2.2; p = 0.008), and prior HF hospitalization (HR 2.2, 95% CI 1.6-3.1; p < 0.001). Conclusions: CKD was highly prevalent among patients with HF, particularly among those with LVEF < 50%. Its presence was associated with a more adverse clinical and echocardiographic profile, as well as higher hospitalization, all-cause mortality, and cardiovascular mortality.

Keywords: Heart failure. Chronic kidney disease. Prevalence. Prognosis. Ecuador.