Incidence and predictors of end-stage renal disease in outpatients with systolic heart failure.

BACKGROUND: Renal dysfunction is an important prognostic factor in heart failure (HF), but whether this dysfunction progresses to end-stage renal disease (ESRD) is unknown. Therefore, we examined incidence and predictors of ESRD in outpatients with HF. METHODS AND
RESULTS: Patients with systolic HF were identified in The Danish Heart Failure database and new-onset ESRD from the Danish Registry on Dialysis. Renal function was estimated by The Chronic Kidney Disease Epidemiology Collaboration equation and patients grouped by estimated glomerular filtration rate (eGFR)-group I: ≥60 mL/min per 1.73 m(2), group II: 30 to 59 mL/min per 1.73 m(2), group III: 15 to 29 mL/min per 1.73 m(2), group IV: <15 mL/min per 1.73 m(2). Cox hazard models for time to ESRD, to death, and the composite end point of ESRD or death were constructed and predictors of ESRD identified. A total of 8204 patients were included in the analyses. Median age was 70 years (Q, 61-77), 28% were women, median left ventricular ejection fraction was 30% (Q, 24-40), and median eGFR was 68 (Q, 51-85) mL/min per 1.73 m(2). Forty-one patients developed ESRD (1.3/1000 patient-years). Baseline eGFR group II (P<0.001), eGFR group III (P<0.001), eGFR group IV (P<0.001), uncontrolled hypertension (P=0.049), need of diuretics, and age <60 years (P=0.016) were associated with time to ESRD.
CONCLUSIONS: ESRD is rare in outpatients with systolic HF and is mainly observed in patients with an eGFR <30 mL/min per 1.73 m(2). A low eGFR, age <60 years, need of diuretics, and uncontrolled hypertension identify patients with an increased risk for ESRD.