Abstract 8874: Diabetes and Chronic Kidney Disease in Heart Failure With Reduced and Preserved

Introduction: Heart Failure (HF) is a major public health burden, but population-based estimates of incidence rates of clinical outcomes by HF category are scarce. We calculated adjusted incidence rates of type 2 diabetes (T2D) and chronic kidney disease (CKD) in patients with HF with preserved (HFpEF) or reduced ejection fraction (HFrEF). Methods: We identified adult patients with a HF diagnosis from 2005-2017 in the electronic medical record of Kaiser Permanent Northwest and calculated age/sex adjusted incidence or progression rates per 1,000 person-years using generalized estimating equations over 15 years of follow-up (2005-2019). Patients with their first diagnosis of T2D or with two eGFR values <60ml/min/1.73m 2 per the CKD-EPI equation recorded after a HF diagnosis were counted as incident cases. Progression of CKD was calculated among those with CKD at baseline defined as deteriorating to a lower eGFR category (category 3a, 45-59 ml/min/1.73m 2 ; 3b, 30-44; 4, 15-29; 5, <15 or ESKD). Progression to insulin was calculated among those with T2D at baseline not already on insulin. Results: Of the 37,773 patients with a HF diagnosis, 36% had no EF available. 46.4% were categorized as HFpEF, 6.7% HFmrEF and 10.9% HFrEF. Compared with HFrEF patients, those with HFpEF were older (72.1 vs. 68.6 years) and more likely to be female (55% vs. 33%). Patients with HFrEF were more likely than HFpEF to develop CKD or have CKD deterioration (Table). However, due to the much larger size of the HFpEF group, HFpEF generated higher absolute numbers of events. Incidence rates and progression of T2D were smaller for both HFrEF and HFpEF. Conclusions: In a large real-world dataset of HF patients, rates of CKD progression were very high in both HFrEF and HFpEF, affecting approximately half of patients with CKD at baseline. Although progression and new incidence of CKD were relatively lower in HFpEF vs. HFrEF, the greater prevalence of HFpEF was driving the majority of heart failure-associated CKD.