The impact of glomerular filtration rate on short-term outcome in elderly patients with heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction is a frequent con-dition among the elderly. The prevalence of chronic kidney disease is also very high, accounting for 5-10% of the population. The aim of this study was to investigate whether the decrease in renal function, assessed by estimated glomerular filtration rate (eGFR), was an independent predictor of adverse events such as death and new hospitalizations in elderly patients hospitalized with heart failure with preserved ejection fraction.This study included hospitalized patients diagnosed with heart failure with preserved ejection fraction. Renal function was estimat-ed by calculating glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration formula. Patients were stratified into two cohorts using the median eGFR value of 45.45 mL/min/1.73 m2 as the cutoff. During a 3-month follow-up, a total of 30 events were recorded. Multivariate logistic analysis adjusted for confounding factors such as age, gender, anemia, and therapy revealed that eGFR was an independent predictive factor in various models: odds ratio (OR): 0.96, 95% confidence interval (CI) 0.93-0.99, p=0.016; OR: 0.95, 95% CI 0.93-0.98, p=0.003. GFR is an independent predictive factor of short-term events in a population of elderly patients with heart failure with preserved ejection fraction. Introduction The overall prevalence of heart failure (HF) fluctuates between 0.2% up to 17.7% and the incidence in the population increases with age and doubles for each decade from 40 to 80 years of age, becom-ing the most frequent cause of hospitalization in people older than 65 years old.1 The main classification of HF is based on the ejection fraction (EF), that reflects the contractile function of left ventricle, including HF with preserved ejection fraction (HFpEF) (EF≥50%), HF with mildly reduced ejection fraction (EF 40-49%) and HF with reduced ejection fraction (HFrEF) (EF≤40%).1,2 The signs and symptoms of HF are attributable to venous congestion and periph-eral tissue hypoperfusion, and they can combine in several ways in the individual patient to compose different clinical pictures various-ly determined by the underlying causes.3 Chronic kidney disease (CKD) refers to the presence of a functional or structural alteration of the kidney, such as proteinuria, morphological alterations on renal biopsy, and alterations on imaging, even in the absence of a reduction in glomerular filtration, documented for at least three months. The prevalence of CKD is also extremely high, accounting for 5-10% of the population.4,5 CKD is now a global health problem, and the treatment of chronic kidney failure in the dialysis phase has reached remarkably high social costs. The number of patients receiving renal replacement treatment is approximately 1.4 million, with an annual increase of 8%. According to the National Kidney Foundation, there are 5 stages of CKD based on estimated glomerular filtrate rate (eGFR), from stage 1 with eGFR>90 mL/min to the end-stage renal disease (or stage 5) with eGFR<15 mL/min.4 Due to the water and salt retention, most of the affected patients are hypertensive and show pleural effu-sion or pulmonary edema. The diagnosis of CKD is possible when morphological alterations of the kidneys are associated with an increase, even slight, in creatinine values for more than 3 months. [page 1] [Geriatric Care 2025; 11:13542]Geriatric Care 2025; volume 11:13542The impact of glomerular filtration rate on short-term outcome in elderly patients with heart failure with preserved ejection fraction Giuseppe Delli Carpini, Cristina Di Bartolomeo, Gianluca Testa, Germano Guerra, Klara Komici Department of Medicine and Health Sciences, University of Molise, Campobasso, ItalyCorrespondence: Klara Komici, Department of Medicine and Health Sciences, University of Molise, Campobasso, 86100 Italy. E-mail: klara.komici@unimol.it Key words: heart failure, heart failure with preserved ejection frac-tion; chronic kidney disease. Contributions: KK, conceptualization; GDC, CDB, investigation, data curation; GG, GT, methodology; GDC, CDB, KK, writing. All authors approved the final version of the manuscript. Conflict of interest: the authors declare no potential conflict of interest. Ethics approval and consent to participate: the study protocol was approved by the Institutional Review Board in accordance with the Helsinki Declaration (protocol number 21/06). Informed consent: participants gave written consent for anonymous clinical data collection. Patient consent for publication: not applicable. Availability of data and materials: data will be available upon reason-able request to the corresponding author. Funding: none. Received: 28 December 2024. Accepted: 12 May 2025. Publisher’s note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi-zations, or those of the publisher, the editors and the reviewers. Any prod-uct that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. ©Copyright: the Author(s), 2025 Licensee PAGEPress, Italy Geriatric Care 2025; 11:13542 doi:10.4081/gc.2025.13542 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).GFR is an independent predictive factor of short-term events in a population of elderly patients with heart failure with preserved ejection fraction.