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Background:  Renal dysfunction is associated with adverse cardiovascular outcomes in patients with heart failure (HF), but its impact on patients with heart failure with preserved ejection fraction (HFpEF) remains unclear.   Methods:  3,392 subjects of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial were assigned to two groups by estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73 m 2  or 30–59 ml/min/1.73 m 2 . The outcomes, including all-cause death, cardiovascular death and HF hospitalization, were examined by multivariable cox models.   Results:  Over a median follow-up of 3.4 ± 1.7 years, a total of 524 all-cause deaths, 334 cardiovascular deaths and 440 HF hospitalizations occurred. Compared with patients with eGFR ≥ 60 ml/min/1.73 m 2 , those with eGFR 30–59 ml/min/1.73 m 2  were associated with an increased risk of the all-cause death [adjusted hazard ratio (HR), 1.47; 95% confidence interval (CI), 1.24–1.76;  P  < 0.001], cardiovascular death (adjusted HR, 1.53; 95% CI: 1.23–1.91;  p  < 0.001), and HF hospitalization (adjusted HR: 1.21; 95% CI: 1.00–1.47;  p  = 0.049) after multivariable adjustment for potential confounders.   Conclusions:  eGFR 30–59 ml/min/1.73 m 2  was related to an increased risk of all-cause death, cardiovascular death and HF hospitalization in HFpEF patients.

Estimated Glomerular Filtration Rate Is Associated With an Increased Risk of Death in Heart Failure Patients With Preserved Ejection Fraction