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Revista Uruguaya de Medicina Interna

Print version ISSN 2393-6797On-line version ISSN 2393-6797


ACLE, Santiago et al. Renal function in outpatients with heart failure with reduced ejection fraction; analysis of its evolution and forecast implications. A 4 year follow up in a Multidisciplinary Unit of Heart Failure. Rev. Urug. Med. Int. [online]. 2018, vol.3, n.3, pp.4-11. ISSN 2393-6797.


Deterioration of renal function is associated with increased mortality in patients with heart failure (HF). The objective of the present study was to assess whether the progression of kidney disease is associated with the appearance of cardiovascular events (CVE), hospitalization for HF and death in a cohort of stable outpatients with chronic kidney disease (CKD) and Heart failure with reduced ejection fraction (HFrEF).


A 4 years follow-up cohort study, with a two stage analysis: time 1 (start of the study); and time 2 (end of study or death). Stable HFrEF was defined as HF with an ejection fraction of the left ventricle (LVEF)<40% without elements of decompensation. An estimated glomerular filtration less than 60 ml / min / 1.73 was used as diagnostic criterion for CKD and stable CKD in the absence of acute renal failure.


A total of 94 patients were included with a follow up mean of 37.2 months; the mean age was 69.5 years ± 9 years, 71.3% were male. Cardiomyopathy was ischemic in 48% and vascular nephropathy was predominant (62%). Cardio-renal syndrome type 2 was diagnosed in 76 (81%) patients. There was a significant decrease in eGFR between the time of analysis (time 1: 45 ± 10 ml/min, time 2: 38 ± 15 ml/min, p <0.001) and 50% of patients worsened their stage of CKD (p = 0.027). An association was found between progression of CKD with a higher frequency of CVD (P = 0.002), hospitalization for HF (OR 3.3, 95% CI 1.9-11.2, p = 0.044) and cardiovascular death (OR 10.9, 95% CI 2.9-40.1, p <0.001).


The progression of CKD is associated with a worse prognosis in not hospitalized HF patients in terms of cardiovascular mortality, admissions for HF and CVE.

Keywords : heart failure with reduced ejection fraction; chronic renal disease; cardio-renal syndrome.

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