Therapeutic challenges and mortality outcomes in HFrEF patients with CKD:a multi-centre and multi-ethnic experience

A.Z. Y., Koh and B. K., Chung and Hwei Sung, Ling and C. Z. F., Chua and W. K., Ho and K. C., Cheah and S. L., Kwa and J., Namasoo and C. H., ChaI and P. W., Ting and M. J., Khaw and J. K. W., Wong and L. Y., Ting and S. Y., Chai and R.S.L., Chew (2025) Therapeutic challenges and mortality outcomes in HFrEF patients with CKD:a multi-centre and multi-ethnic experience. European Journal of Heart Failure, 27 (Supp.2). pp. 298-297. ISSN 1879-0844

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Abstract

Introduction: The presence of chronic kidney disease (CKD) in patients with heart failure (HF) is associated with increased complications, readmissions, and mortality. CKD can also limit the application of guideline-directed medical therapy (GDMT) for HF in routine clinical practice. The comparative clinical outcomes of HF patients with CKD versus non-CKD patients in dedicated HF clinics remain uncertain. Purpose: To evaluate the characteristics and clinical outcomes of patients with chronic heart failure with reduced ejection fraction (HFrEF) and CKD compared to non-CKD patients. Methods: A retrospective, multi-center cohort study analyzed 465 patients with HFrEF who attended dedicated HF clinics in ten hospitals between January 1, 2021, and June 30, 2023. Clinical records, baseline characteristics, and six-month clinical outcomes were evaluated. CKD is defined as having an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73m2 according to the 2021 CKD-EPI. Results: Among the 465 patients, 129 (27.7%) had CKD and 336 (72.3%) were non-CKD. CKD patients were significantly older (61±11 years vs. 53±13 years, p=0.002), but both groups had a similar male predominance (77% vs. 77%, p=0.487). CKD patients exhibited higher rates of hypertension (79% vs. 61%, p<0.001), diabetes mellitus (50% vs. 35%, p=0.002), dyslipidemia (61% vs. 49%, p=0.014), cerebrovascular accidents (12% vs. 6%, p=0.033), and anemia (39% vs. 22%, p<0.001). However, there were no significant differences in the prevalence of ischemic heart disease (50% vs. 44%, p=0.157) or atrial fibrillation (25% vs. 22%, p=0.292). The prescription of renin-angiotensin-aldosterone system (RAAS) inhibitors was significantly lower in the CKD group at first clinic visit (69% vs. 88%, p<0.001), three months (73% vs. 93%, p<0.001), and six months (78% vs. 92%, p<0.001). In contrast, prescriptions of beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors were similar across groups at all time points. Both groups demonstrated significant improvement in left ventricular ejection fraction (LVEF) over six months, with no intergroup differences: 29.3±9.8% to 37.2±14.1% (CKD) vs. 26.9±7.8% to 38.3±13.0% (non-CKD, p=0.161). Similarly, there was no significant difference in improvement in NYHA functional class (p=0.795). However, the CKD group experienced higher six-month all-cause mortality (16.5% vs. 5.6%, p<0.001), while the six-month HF readmission rate was comparable (10.9% vs. 6.0%, p=0.057). Conclusion: Both CKD and non-CKD patients with HFrEF showed improvement in LVEF and NYHA functional class during follow-up in dedicated HF clinics. However, CKD patients had lower RAAS inhibitor prescriptions and significantly higher six-month all-cause mortality, emphasizing the need for optimized management strategies for this high-risk group.

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