Abstract
Background: Renal dysfunction is associated with adverse cardiovascular outcomes in patients with heart failure (HF), but its impact on patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. Methods: 3,392 subjects of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial were assigned to two groups by estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m(2) or 30-59 ml/min/1.73 m(2). The outcomes, including all-cause death, cardiovascular death and HF hospitalization, were examined by multivariable cox models. Results: Over a median follow-up of 3.4 ± 1.7 years, a total of 524 all-cause deaths, 334 cardiovascular deaths and 440 HF hospitalizations occurred. Compared with patients with eGFR ≥ 60 ml/min/1.73 m(2), those with eGFR 30-59 ml/min/1.73 m(2) were associated with an increased risk of the all-cause death [adjusted hazard ratio (HR), 1.47; 95% confidence interval (CI), 1.24-1.76; P < 0.001], cardiovascular death (adjusted HR, 1.53; 95% CI: 1.23-1.91; p < 0.001), and HF hospitalization (adjusted HR: 1.21; 95% CI: 1.00-1.47; p = 0.049) after multivariable adjustment for potential confounders. Conclusions: eGFR 30-59 ml/min/1.73 m(2) was related to an increased risk of all-cause death, cardiovascular death and HF hospitalization in HFpEF patients.