Clinical Features and Outcomes of Patients with Heart Failure and Advanced Chronic Kidney Disease

Objectives: The aim was to evaluate the clinical features, management and 1-year outcomes in patients with heart failure (HF) and advanced chronic kidney disease (CKD) who were followed in specialized HF units in Spain. Methods: Data from the registry of the SEC-Excellent-HF quality program of the Spanish Society of Cardiology were analyzed. This registry included 1567 patients between 2019 and 2022 followed by 45 specialized HF units. Clinical features, treatment and 1-year rate of events (death and HF hospitalizations) were compared between the groups of advanced CKD (glomerular filtration rate <30 mL/minute/m2) and GFR ≥ 30 mL/min/m2. Results: 11.1% of patients had a GFR < 30 and 88.9% ≥ 30 mL/min/m2. The median LVEF was similar in groups with GFR < 30 and ≥30 mL/min/m2: 42% (IQR 30–58) versus 38% (IQR 29–54). Advanced CKD patients were older, had more severe HF (previous HF admissions in the last year, worse NYHA functional class and longer evolution time) and had higher prevalence of ischemic heart disease, diabetes mellitus, systemic hypertension, iron deficiency, anemia and hyponatremia. All drugs for HF, except for diuretics and potassium binders, were used in a lower proportion in patients with GFR < 30 mL/min/m2 (p < 0.001). One-year overall mortality (49.2 versus 13.7/100 patients-year; p < 0.001) and one-year HF hospitalizations rate (83.2 versus 30.7/100 patients-year; p < 0.001) were higher in the group of advanced CKD. Conclusions: In our study, patients with advanced CKD had different clinical characteristics, received indicated treatment in a lower proportion and had higher 1-year rates of death and HF admissions.