Different impact of chronic kidney disease in older patients with heart failure according to frailty

Abstract Introduction Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the impact of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF. Methods Our data come from the FRAGIC study ("Study of the impact of frailty and other geriatric syndromes on the clinical management and prognosis of older outpatients with heart failure"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Results We included 499 patients, mean age 81.4 ± 4.3 years, 38% women. Mean estimated glomerular filtration rate (eGFR) was 52.1±17.5 ml/min/1.72 m2. Patients were classified in three groups: eGFR ≥60 ml/min/1.72m2 (normal: 182 patients, 36%), eGFR 30-59 ml/min/1.72m2 (moderately impaired: 261 patients, 52.7%), and eGFR < 30 ml/min/1.72m2 (severely impaired: 56 patients, 11.3%). Patients with severe renal dysfunction were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. Baseline variables according to eGFR group are depicted in Table 1. After a median follow up of 371 days, 58 patients (11.6%) died. One year mortality was higher in patients with worse renal function (8.8%, 11% and 21% according to normal, moderate and severe renal dysfunction respectively, p=0.036) and in frail patients (Figure 1). In multivariate analysis, frailty, but not severe renal dysfunction, was associated with one year mortality (frailty HR 2.05 95%CI 1.11-3.78 p 0.021, eGFR < 30 and 30-60 ml/min/1.72m2 HR 1.39 95%CI 0.62-3.09 p0.424 and 1.09 95%CI 0.58-2.09 p0.793 respectively). Conclusions Most HF patients ≥75 years have renal dysfunction. The association between renal function and clinical outcomes is different according to frailty status. CKD is related to worse prognosis only in non-frail patientsCumulative incidence of 1-year mortalityTable 1.Baseline characteristics