{"id":"a1b6841c0c82","type":"article","url":"https://hartvaat.nl/2026/02/06/nierfunctiebeloop-bij-nieuw-ontstaan-hfref-voorspelt-de-uitkomst/","title":"Nierfunctiebeloop bij nieuw ontstaan HFrEF voorspelt de uitkomst","title_en":"Renal function trajectories in 'de novo' heart failure with reduced ejection fraction: impact on outcomes","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","bisoprolol","bloeddrukbehandeling","chronische-nierziekte","cystatine-c","dapa-hf","dapagliflozine","empagliflozine","emperor-trials","hfmref","hfpef","hfref","ijzertekort","nierfalen","nt-probnp","sacubitril-valsartan","step-hfpef","vrouwen"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003193?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003193?rss=1","authors":["Otero Garcia","O.","Donoso Trenado","V.","de la Fuente-Lopez","P.","Lopez Vilella","R.","Adarraga-Gomez","J.","Yebra Pimentel-Brea","C.","Gallego-Latorre","G.","Gomez-Otero","M. I.","Bouzas Cruz","N.","Garcia-Vega","D.","Almenar Bonet","L.","Gonzalez Juanatey","J. R."],"significance":5,"published":"2026-02-06","source_date":"2026-02-06","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"Heart failure (HF) often coexists with chronic kidney disease (CKD), affecting prognosis. This prospective cohort followed renal function in patients hospitalised with new-onset heart failure with reduced ejection fraction (de novo HFrEF) at two university hospitals. Of 306 patients analysed, 24.6% had an eGFR <45 mL/min/1.73 m² at discharge. Higher eGFR at discharge was associated with better outcomes. During follow-up, 79.1% had an eGFR ≥45; patients with stable or improved renal function had lower mortality and fewer readmissions. Factors associated with improvement or stabilisation included less prior CKD, hypertension, younger age, higher eGFR at discharge and greater use of quadruple HF therapy. Routine renal function assessment in de novo HFrEF is thus important to personalise treatment.","created":"2026-07-03T10:32:26Z","updated":"2026-07-03T18:39:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Hartfalen (HF) gaat vaak samen met chronische nierziekte (CKD), wat de prognose beïnvloedt. Deze prospectieve cohortstudie volgde de nierfunctie bij patiënten die werden opgenomen met nieuw ontstaan hartfalen met verminderde ejectiefractie (de novo HFrEF) in twee universitaire ziekenhuizen. Van de 306 geanalyseerde patiënten had 24,6% bij ontslag een eGFR <45 ml/min/1,73 m². Een hogere eGFR bij ontslag ging gepaard met betere uitkomsten. Tijdens de follow-up had 79,1% een eGFR ≥45; patiënten met een stabiele of verbeterde nierfunctie hadden een lagere sterfte en minder heropnames. Factoren die samenhingen met verbetering of stabilisatie waren minder voorafgaande CKD, hypertensie, een jongere leeftijd, een hogere eGFR bij ontslag en meer gebruik van viervoudige hartfalentherapie. Routinematige beoordeling van de nierfunctie bij de novo HFrEF is dus belangrijk om de behandeling te personaliseren.","abstract_original":"Aims\n

Heart failure (HF) often coexists with chronic kidney disease (CKD), impacting prognosis. This study aims to evaluate renal function trajectories and their impact on major clinical outcomes in a cohort of patients hospitalised for ‘de novo’ HF with reduced ejection fraction (HFrEF).

\n\nMethods\n

This is a prospective cohort study that included patients hospitalised for ‘de novo’ HFrEF at two university hospitals. Renal function was assessed using the CKD-Epidemiology Collaboration formula. Total mortality and the combined total mortality and HF readmissions were evaluated during follow-up.

\n\nResults\n

Of 370 patients, 306 were eligible. At discharge, 24.6% had estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2. Higher eGFR at discharge was associated with better outcomes. During follow-up, 79.1% showed eGFR ≥45 mL/min/1.73 m2. Patients with stable or improved eGFR had lower total mortality and HF readmission rates. Factors associated with renal function improvement or stabilisation included less prior CKD, hypertension and younger age, higher eGFR values at discharge and more use of quadruple therapy at the end of uptitration period.

\n\nConclusions\n

In patients with ‘de novo’ HFrEF, renal function deterioration at discharge correlated with poorer outcomes. However, stabilisation or improvement during follow-up was linked to better prognosis. Routine renal function assessment is crucial in HFrEF management, guiding personalised treatment strategies to mitigate renal function decline and improve patient care.

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