Abstract: FR-PO357
Heart Failure with Preserved Ejection Fraction (HFpEF), Heart Failure with Reduced Ejection Fraction (HFrEF), and the Risk of ESKD in Type 2 Diabetes (T2D)
Session Information
- Hypertension, CVD, and the Kidneys: Epidemiology
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Kim, David, University of Utah Health, Salt Lake City, Utah, United States
- Sarwal, Amara, University of Utah Health, Salt Lake City, Utah, United States
- Wei, Guo, University of Utah Health, Salt Lake City, Utah, United States
- Boucher, Robert E., University of Utah Health, Salt Lake City, Utah, United States
- Singh, Ravinder, University of Utah Health, Salt Lake City, Utah, United States
- Hartsell, Sydney Elizabeth, University of Utah Health, Salt Lake City, Utah, United States
- Drakos, Stavros, University of Utah Health, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, University of Utah Health, Salt Lake City, Utah, United States
Background
We examined the hypothesis that kidney blood flow is more compromised in HFrEF compared to HFpEF and, as a result, there is a higher risk of ESKD in HFrEF compared to HFpEF in T2D.
Methods
Using the VA informatics and Computing Infrastructure (VINCI), in a cohort of 2.79 million veterans with a diagnosis of T2D from 1/1/2010 to 12/31/2018, we identified a cohort of 316,762 veterans with first time incident HF hospitalizations. Using a validated algorithm and natural language processing, ejection faction (EF) data was obtained. HF was classified as HFpEF (EF >50), HFrEF (EF <40), HFmrEF (EF 40 to 50) and no EF (no data). Index date was HF hospitalization date. Follow-up was until 12/31/2021. ESKD data was obtained by linkage to US Renal Data System data. In multivariate Cox regression models, we related HF subtypes to the risk of ESKD.
Results
Mean age 72 ± 11 years, 98% male, 17% Black, Mean eGFR 64 ± 29. There were 15,126 ESKD events/1,222,038 years of follow-up. HFrEF had the lowest incidence and HFpEF the highest incidence of ESKD (Figure). These associations were attenuated in multivariate cox regression models (Table).
Conclusion
The risk of developing ESKD is higher in the HFpEF compared to HFrEF but adjusting for baseline covariates attenuated this association. Thus, both HFpEF and HFrEF have similar risk for ESKD.
HR (95% CI) for ESKD
| HFrEF (<40) | HFmrEF (40 to <50) | HFpEF (>50) | No EF | |
| Model 1 | Reference | 1.26 (1.20, 1.33) | 1.48 (1.41, 1.54) | 1.20 (1.15, 1.26) |
| Model 2 | Reference | 1.02 (0.97, 1.08) | 1.02 (0.97, 1.06) | 1.06 (1.01, 1.11) |
Model 1 - demographics, CHF diagnosis setting. Model 2 - Model 1 + comorbidities, SBP, DBP, BMI, CKD, diabetes meds, BP meds, HbA1c
Funding
- NIDDK Support