title: Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study.
abstract: BACKGROUND
  There is scant evidence on the effect that chronic kidney disease (CKD) confers on clinically meaningful outcomes among patients with heart failure with preserved left ventricular ejection fraction (HF-PEF).
  
  
  RESULTS
  We identified a community-based cohort of patients with HF. Electronic medical record data were used to divide into HF-PEF and reduced left ventricular EF on the basis of quantitative and qualitative estimates. Level of CKD was assessed by estimated glomerular filtration rate (eGFR) and by dipstick proteinuria. We followed patients for a median of 22.1 months for outcomes of death and hospitalization (HF-specific and all-cause). Multivariable Cox regression estimated the adjusted relative-risk of outcomes by level of CKD, separately for HF-PEF and HF with reduced left ventricular EF. We identified 14 579 patients with HF-PEF and 9762 with HF with reduced left ventricular EF. When compared with patients with eGFR between 60 and 89 mL/min per 1.73 m(2), lower eGFR was associated with an independent graded increased risk of death and hospitalization. For example, among patients with HF-PEF, the risk of death was nearly double for eGFR 15 to 29 mL/min per 1.73 m(2) and 7× higher for eGFR<15 mL/min per 1.73 m(2), with similar findings in those with HF with reduced left ventricular EF.
  
  
  CONCLUSIONS
  CKD is common and an important independent predictor of death and hospitalization in adults with HF across the spectrum of left ventricular systolic function. Our study highlights the need to develop new and effective interventions for the growing number of patients with HF complicated by CKD.
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA. david.h.smith@kpchr.org
authors.forename: David H
authors.initials: DH
authors.lastname: Smith
authors.forename: Micah L
authors.initials: ML
authors.lastname: Thorp
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.forename: Grace
authors.initials: G
authors.lastname: Hsu
authors.forename: Sue Hee
authors.initials: SH
authors.lastname: Sung
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Alan S
authors.initials: AS
authors.lastname: Go
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000628:therapy; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left
keywords: chronic kidney disease; heart failure; hospitalization; mortality