Purpose: We investigated the prevalence of different CKD stages and changes in renal function in the effect of treatment optimization (TO) in patients (pts) with heart failure with reduced ejection fraction (HFrEF) followed at our heart failure outpatient clinic (HFOC).
Methods : The prevalence of different CKD stages were assessed in 469 pts with HFrEF managed at our HFOC (male:77.19%, age:62.58±12.6 years, NYHA:3.12±0.78%, LVEF:26.88±6.51%, eGFR: 51.45±19.25ml/min/1.73m2). The change in eGFR before and after TO was also determined in the whole patient group and in pts with different CKD stages.
Results: In 29.63% of pts eGFR was above 60 ml/min/1.73m2 (CKD1-2), in 59.70% was 30-60 ml/min/1.73m2 (CKD3a-3b) and in 10.66% was under 30 ml/min/1.73m2 (CKD4-5) at baseline. After TO 19.40% of pts was at CKD1-2, 63.75% at CKD3a-3b and 16.84% at CKD4-5 stage. After TO significant eGFR decrease was detected in the whole population (51.45±19.25 ? 46.03±17.09 ml/min/1.73m2; p<0.001), at baseline CKD1-2 (74.06±14.84 ? 58.81±17.29 ml/min/1.73m2; p<0.001) and baseline CKD3a-3b (45-18±8-67 ? 43-57±15-06 ml/min/1.73m2; p<0.001) pts compared to eGFR parameters before TO. Pts with CKD4-5 at baseline showed significant eGFR improvement (23.73±6,15 ? 29.78±11,37 ml/min/1.73m2; p<0.005.) Neurohormonal antagonist usage did not show significant difference after TO in pts with CKD1-2 (BB: 89.01%, ACEi/ARB: 98.90%, MRA: 57.14%), CKD3a-3b (BB: 94.31%, ACEi/ARB: 97.99%, MRA: 66.22%) and CKD4-5 (BB: 93.67%, ACEi/ARB: 94.94%, MRA: 58.23%).
Conclusions: The prevalence of CKD in HFrEF population is very high. Based on our study results renal function worsening was detected after TO in mild and moderate CKD pts, however, renal function improvement was proved in the most severe CKD4-5 pts. Our data suggests that we should strive to achieve optimal neurohormonal antagonist therapy in CKD4-5 pts too, partly because, based on previous data, the severe CKD patient group is one of the pts who benefit most from this treatment and partly because, based on our study results it seems safe treatment option in this group of patients.