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

Background Limited 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. Methods Data 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. Results 8569 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. Conclusions Slowing 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. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors have no funding to report. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The PREVEND study was approved by the University Medical Center Groningen medical ethics committee and conducted in accordance with the Declaration of Helsinki. All subjects provided written informed consent. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.