Evaluation, clinical and prognostic role of chronic kidney disease markers in outpatients with heart failure in real-world practice: data from the PRIORITY-HF study

Aim. To evaluate markers of chronic kidney disease (CKD) and their clinical and prognostic role in outpatients with heart failure (HF) based on real-world data.

Material and methods. This retrospective analysis of data from the prospective observational multicenter registry study of patients with heart failure in Russia (PRIORITY-HF) was performed, including 19981 patients. To assess CKD markers, the following data obtained at Visit 1 were taken into account: "Has the diagnosis of Chronic Kidney Disease (CKD) been confirmed?", "CKD stage", "CKD-EPI Estimated glomerular filtration rate (eGFR)", "Creatinine", "Albumin" or "Albumin/ creatinine ratio" in a single urine portion. eGFR values entered in case report form were compared with the CKD-EPI 2021 eGFR values based on the patient’s sex, age and the entered serum creatinine (aGFR). Clinical characteristics, therapy after Visit 1 and prognosis were compared in patients with CKD and depending on aGFR value.

Results. The following diagnostic problems were identified: incorrect GFR estimation with more frequent underestimation of values and insufficient assessment of albuminuria. CKD was noted as a concomitant diagnosis in 44,7% of patients with HF, but aGFR <60 ml/min/1,73 m² was determined in 30,8% of cases. Groups with both reported CKD and aGFR were characterized by a more severe HF course, a greater burden of most cardiovascular and non-cardiovascular (obesity, diabetes mellitus and anemia) comorbidities. A decrease in prescription rate of most classes of guideline-directed medical therapy for HF and quadruple therapy with aGFR <30 ml/min/1,73 m² was noted. Both CKD and a decrease in aGFR <60 ml/min/1,73 m² were associated with a higher rate of adverse events. A decrease in eGFR by every 10 ml/min/1,73 m² was significantly associated with all adverse outcomes with extensive adjustment.

Conclusion. The high prevalence of CKD in the cohort of HF patients, the identified diagnostic problems, a more severe clinical course of HF, and an unfavorable prognosis emphasize the need for comprehensive measures to increase physician awareness and optimize the implementation of guidelines in real-world practice.

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