Chronic Kidney Disease in Patients With Heart Failure With a Preserved Ejection Fraction

The prevalence of impaired kidney function in patients with heart failure with preserved ejection fraction (HFpEF) is estimated to be 15% to 25%.

• The conventional threshold for identifying intrinsic renal disease in HFpEF is an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m, but this does not account for age-related changes.
• When adjusted for age, the appropriate threshold for eGFR is <45 mL/min/1.73 m.
• The risk of end-stage kidney disease in HFpEF patients is very low, estimated at <0.5% annually.
• Pharmacological efforts to manage hypertension and diabetes have not shown beneficial effects on kidney function or the risk of end-stage kidney disease in HFpEF patients.
• Obesity and visceral fat are identified as the primary contributors to chronic kidney disease in HFpEF, linked to neurohormonal activation and imbalances in fat-derived signaling molecules.
• Bariatric surgery and GLP-1 receptor agonists may help reduce the risk of both HFpEF and adverse kidney outcomes by alleviating obesity and visceral fat.

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