Journal of the American College of Cardiology

Chronic Kidney Disease in Heart Failure Patients with Normal Pumping Function Linked to Belly Fat

Updated

Abstract

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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Funding

Competing interests

Funding Support and Author Disclosures Dr Packer has received consulting fees from AbbVie, Actavis, Alnylam, Altimmune, Ardelyx, Amgen, ARMGO, AstraZeneca, Attralus, Biopeutics, Boehringer Ingelheim, Caladrius, Casana, CSL Behring, Cytokinetics, Daiichi-Sankyo, Eli Lilly and Company, Imara, Medtronic, Moderna, Novartis, Pharmacosmos, Regeneron, and Salamandra. Dr Testani has received grants from Boehringer Ingelheim, Bristol Myers Squibb, Reprieve Inc, Sequana Medical, Abbott, and Merck; and has done consulting for Boehringer Ingelheim, Bristol Myers Squibb, Cardionomic, MagentaMed, Reprieve Inc, FIRE1, Sequana Medical, Merck, Windtree Therapeutics, Precardia, Regeneron, BD, Edwards Lifesciences, AstraZeneca, Corteria, and Lilly. Dr Butler has relationships with Abbott, American Regent, Amgen, Applied Therapeutic, AskBio, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardiac Dimension, CardioCell, Cardior, CSL Bearing, CVRx, Cytokinetics, Daxor, Edwards, Element Science, Faraday, Foundry, G3P, Innolife, Impulse Dynamics, Imbria, Inventiva, Ionis, Levator, Lexicon, Lilly, LivaNova, Janssen, Medtronic, Merck, Occlutech, Owkin, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Prolaio, Pulnovo, Regeneron, Renibus, Roche, Salamandra, Salubris, Sanofi, SC Pharma, Secretome, Sequana, SQ Innovation, Tenex, Tricog, Ultromics, Vifor, and Zoll. Dr Zannad has relationships with Alnylam, Bayer, Biopeutics, Boehringer, CellProthera, Cereno, Centrix, Corteria, CVRx, CVCT, Lilly, Lupin, Merck, Novo Nordisk, Opalia Recordati, Owkin, Polygon, Ribocure, Riche, and Viatri. Dr Zannad is on steering committees and data and safety monitoring and advisory boards for Alnylam, Bayer, Biopeutics, Boehringer, CellProthera, Cereno, Corteria, CVRx, Merck, Owkin, Ribocure, and Roche; owns equities and stock options in Polygon, Cereno Pharmaceutical, and CVCT; and is on the Speakers Bureau for Bayer, Boehringer, Centrix, CVRx, Lupin, Opalia Recordati, Merck, Novo Nordisk, and Viatris. Dr Lam has received support from Novo Nordisk and Roche Diagnostics; has served as consultant or on the advisory board/steering committee/executive committee for Alnylam Pharma, AnaCardio AB, Applied Therapeutics, AstraZeneca, Bayer, Biopeutics, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Corteria, CPC Clinical Research, Cytokinetics, Eli Lilly, Impulse Dynamics, Intellia Therapeutics, Ionis Pharmaceutical, Janssen Research & Development LLC, Medscape/WebMD Global LLC, Merck, Novartis, Novo Nordisk, Quidel Corporation, Radcliffe Group Ltd., Roche, and Us2.ai; and is the cofounder and nonexecutive director of Us2.ai. Dr Vaduganathan has received research grant support, served on advisory boards, or had speaker engagements with Alnylam Pharmaceuticals, American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, BMS, Boehringer Ingelheim, Chiesi, Cytokinetics, Esperion, Fresenius Medical Care, Idorsia Pharmaceuticals, Lexicon Pharmaceuticals, Merck, Milestone Pharmaceuticals, Novartis, Novo Nordisk, Pharmacosmos, Recordati, Relypsa, Roche Diagnostics, Sanofi, and Tricog Health; and participates on clinical trial committees for studies sponsored by Amgen, AstraZeneca, Galmed, Novartis, Bayer AG, Occlutech, Pharmacosmos, and Impulse Dynamics. Dr Fang was on the clinical adjudication committee for several clinical trials for Abbott and the data and safety monitoring board for Reprieve. Dr Borlaug receives research support from the National Institutes of Health (NIH) and the U.S. Department of Defense, as well as research grant funding from AstraZeneca, Axon, Corvia, Novo Nordisk, and Tenax Therapeutics; has served as a consultant for Actelion, Amgen, Aria, Axon Therapies, BD, Boehringer Ingelheim, Cytokinetics, Edwards Lifesciences, Lilly, Imbria, Janssen, Merck, Novo Nordisk, NGM, NXT, and VADovations; and is named inventor (U.S. Patent no. 10,307,179) for the tools and approach for a minimally invasive pericardial modification procedure to treat heart failure.
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