Transitions across Kidney Disease Stages and Association with New-onset Heart Failure: a Population-Based study of 8569 Individuals and 12.6 Years of Follow-up

BackgroundLimited data exist on transitions across Kidney Disease Improving Global Outcomes (KDIGO) risk stages and association with new-onset heart failure (HF) in the general population. MethodsData were extacted from the first four clinical examinations of the PREVEND study. Participants were categorized into eGFR and albuminuria risk stages according to KDIGO Guideline. Multi-state model was fitted to estimate the transition rates across consecutive KDIGO risk stages and the association with new-onset HF. Results8569 participants were included at baseline. During a median follow-up of 12.6 years, 373 participants were diagnosed with new-onset HF and 710 participants had died before new-onset HF. The transition rate from low risk to intermediate risk stage did not differ between women and men; it increased from 0 to 10 transitions per 100 person-years from age 50 to 75 years. The transition rate from intermediate risk to high or very high risk stage increased exponentially with age, with women having lower rates (HR: 0.50, 95%CI: 0.34-0.76). Younger subjects and women were more likely to make a backward transition from intermediate risk to low risk stage. More advanced KDIGO risk stages were associated with increased risk of new-onset HF, and the risk association attenuates with age on the relative scale but strengthens with age on the absolute scale. ConclusionsSlowing the progression of KDIGO risk stages may result in an important reduction in the incidence of new-onset heart failure in this population of middle-aged subjects.