Clinical Features and Outcomes of Patients with Heart Failure and Advanced Chronic Kidney Disease: A Dangerous Association

Aims: To analyze in a contemporary registry of heart failure (HF) patients followed in specialized HF units in Spain the differences in clinical features, treatment and 1-year outcomes in HF with advanced chronic kidney disease (CKD). Methods and results: We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 1,567 patients with HF included between 2019 and 2022 by 45 specialized HF units. Treatment and 1-year mortality and HF hospitalizations rate were compared according to the existence of advanced CKD (glomerular filtration rate < 30 ml/minute/m2). Of the 1,567 patients, 11.1% had a GFR<30 and 88.9% ≥ 30 mL/min/m2. Median LVEF was similar in both groups: 42 (30-58) vs 38% (29-54). The group with advanced CKD was older (77±9.6 vs 70.5±12.6 years; p<0.001), had greater HF severity (more admissions for HF in the last year, worse NYHA functional class and longer evolution time), and a higher prevalence of coronary heart disease, hypertension, diabetes mellitus, anemia, iron deficiency and hyponatremia. Patients with GFR <30 received in a significantly lower proportion all drugs for HF (p<0.001), except diuretics and potassium binders. One-year mortality (49.2 versus 13.7/100 persons-year; p<0-001) and 1-year HF hospitalizations rate (83.2 versus 30.7/100 persons-year; p<0,001) were higher in patients with HF and advanced CKD. Conclusions: In our contemporary cohort of real-life HF patients, patients with advanced CKD showed different clinical features, received indicated treatment in a lower proportion and had higher 1-year mortality and HF hospitalization rates.