TOPLINE

Chronic kidney disease (CKD) was independently associated with new-onset heart failure (HF) across all HF phenotypes, and the association was strongest for HF with preserved ejection fraction (HFpEF) and was more pronounced as kidney disease advanced.

METHODOLOGY

• Using data from the Swedish Heart Failure Registry, researchers conducted a retrospective matched case-control study to evaluate the association of CKD with new-onset HF across the EF spectrum.
• The study included 51,848 patients (median age, 74 years; 63% men) with new-onset HF between 2005 and 2021 who were matched to 51,848 control patients without HF.
• HF was classified as HFpEF (EF ≥ 50%), HF with mildly reduced EF (HFmrEF; EF, 40%-49%), and HF with reduced EF (HFrEF; EF < 40%).
• CKD was defined using either standard diagnostic codes recorded during the preceding 5 years among patients with HF and matched control patients or an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m² among patients with HF.
• The researchers grouped patients according to Kidney Disease: Improving Global Outcomes stages — G2 (reference; eGFR, 60-89 mL/min/1.73 m²), G3a (mild CKD; eGFR, 45-59 mL/min/1.73 m²), G3b (moderate CKD; eGFR, 30-44 mL/min/1.73 m²), G4 (advanced CKD; eGFR, 15-29 mL/min/1.73 m²), and G5 (kidney failure; eGFR < 15 mL/min/1.73 m²) — to assess whether the association of CKD with HF differed by the severity of CKD.

TAKEAWAY

• CKD defined using standard diagnostic codes was associated with higher odds of new-onset HF after adjustment (odds ratio [OR], 1.63; 95% CI, 1.45-1.84).
• The association differed across HF phenotypes and was strongest for HFpEF (OR, 2.46; 95% CI, 1.91-3.16), followed by HFrEF (OR, 1.52; 95% CI, 1.29-1.78) and HFmrEF (OR, 1.30; 95% CI, 1.02-1.66; P for interaction < .001).
• CKD defined using the eGFR was associated with 8% higher odds of new-onset HFpEF vs HFrEF (95% CI, 1.02-1.14) and 11% lower odds of new-onset HFmrEF vs HFrEF (95% CI, 0.85-0.94).
• The association between CKD and HFpEF strengthened with increased CKD severity, with moderate-to-advanced CKD strongly associated with HFpEF. Mild CKD showed similar associations with HFpEF and HFrEF, whereas mild-to-moderate CKD showed weaker associations with HFmrEF than with HFrEF.

IN PRACTICE

"Our findings have important implications for the management of patients with CKD. The prevention of HF in this high-risk population should be considered a public health priority," the researchers of the study wrote.

SOURCE

The study was led by Valeria Valente, Karolinska Institutet, Stockholm, Sweden. It was published online on July 19, 2026, in ESC Heart Failure.

LIMITATIONS

The retrospective, registry-based design precluded causal inference. CKD definitions based on standard diagnostic codes may have underestimated the prevalence of CKD and introduced misclassification. The findings may not have fully applied to populations outside Sweden because of differences in patient populations and patterns of care.

DISCLOSURES

This study did not report any funding sources. Several authors disclosed receiving grants, honoraria for lectures, consulting fees, lecture fees, speaker or advisory board fees, and personal fees from multiple companies and institutions, including a hospital, outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.