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

作者：Milton Packer, Jeffrey M. Testani, Javed Butler, Faı̈ez Zannad, Carolyn S.P. Lam, Muthiah Vaduganathan, James C. Fang, Barry A. Borlaug · 发表于：Journal of the American College of Cardiology · 年份：2025 · DOI：10.1016/j.jacc.2025.08.086 · 被引用次数：8 · 研究领域：Cardiovascular Function and Risk Factors、Diabetes Treatment and Management、Neurological and metabolic disorders

It has been hypothesized that an impairment of kidney function may contribute to the development of heart failure with a preserved ejection fraction (HFpEF). However, the conventional threshold for the identification of intrinsic renal disease in HFpEF (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) does not consider age-related physiological changes. When adjusted for age, the appropriate threshold is <45 mL/min/1.73 m2, leading to a prevalence of impaired glomerular function of ≈15% to 25% among patients with HFpEF. However, even this estimate of chronic kidney disease is inflated, since heart failure and its treatments lead to reversible changes in renal perfusion, renal venous pressures, and intrarenal hemodynamic changes, which do not reflect structural kidney disease. Accordingly, the risk of end-stage kidney disease in patients with HFpEF is exceptionally low, ie, <0.5% annually, far lower than the risk of death. It is generally assumed that hypertension and diabetes are the most important modifiable risk factors for the development of kidney disease in patients with HFpEF. However, in large-scale trials, pharmacological efforts to lower blood pressure or blood glucose have not had favorable effects on glomerular function or the risk of end-stage kidney disease. Instead, the principal driver of chronic kidney disease in patients with HFpEF appears to be obesity and visceral adiposity. Both obesity and visceral adiposity are accompanied by neurohormonal...