{"id":"46041","type":"article","url":"https://hartvaat.nl/2026/04/27/nierfunctiestoornis-verergert-pulmonale-vaatziekte-bij-hfpef/","title":"Nierfunctiestoornis verergert pulmonale vaatziekte bij HFpEF","title_en":"Kidney Dysfunction and Pulmonary Vascular Disease in Heart Failure with preserved Ejection Fraction.","category":"chronische nierziekte","category_label":"Nierziekte","professions":["cardioloog","internist"],"tags":[],"journal":"European journal of heart failure","doi":"10.1093/ejhf/xuag140","source_url":"https://doi.org/10.1093/ejhf/xuag140","authors":["Matthew B Amdahl","Jwan A Naser","Atsushi Tada","Shunichi Doi","Tomonari Harada","Tatsuro Ibe","Jeffrey M Testani","Vojtech Melenovsky","Yogesh N V Reddy","Barry A Borlaug"],"significance":7,"published":"2026-07-16","source_date":"2026-04-27","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/obesitas-en-hart/"],"congress":"","summary_en":"Chronic kidney disease (CKD) is common in heart failure with preserved ejection fraction (HFpEF) and is linked to worse outcomes via unclear mechanisms. In this cohort of 925 HFpEF patients undergoing invasive haemodynamic exercise testing (34.5% with eGFR <60), worse kidney function was associated with higher biventricular filling pressures, lower cardiac output and — most strikingly — increasing pulmonary vascular disease: pulmonary vascular resistance rose and pulmonary arterial compliance fell as kidney function declined. During exercise these differences became even more pronounced, with the greatest cardiac-output limitation in the worst kidney function. CKD thus contributes to progressive pulmonary vascular disease in HFpEF.","created":"2026-07-03T20:27:09Z","updated":"2026-07-04T19:26:58Z","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":"Chronische nierschade (CKD) komt vaak voor bij hartfalen met behouden ejectiefractie (HFpEF) en gaat gepaard met slechtere uitkomsten via onduidelijke mechanismen. In dit cohort van 925 HFpEF-patiënten die invasieve hemodynamische inspanningstests ondergingen (34,5% met eGFR <60) hing een slechtere nierfunctie samen met hogere biventriculaire vuldrukken, een lagere cardiac output en — het meest opvallend — toenemende pulmonale vaatziekte: de pulmonale vaatweerstand steeg en de pulmonale arteriële compliantie daalde naarmate de nierfunctie verslechterde. Tijdens inspanning werden deze verschillen nog uitgesprokener, met de sterkste beperking van de cardiac output bij de slechtste nierfunctie. CKD draagt bij HFpEF dus bij aan progressieve pulmonale vaatziekte.","abstract_original":"AIMS: Chronic kidney disease (CKD) is common in patients with heart failure (HF) with preserved ejection fraction (HFpEF), and its presence is associated with more severe echocardiographic abnormalities and poorer outcomes through unclear mechanisms. CKD-associated endothelial dysfunction, inflammation, and activation of profibrotic pathways could worsen pulmonary vascular disease (PVD) in HFpEF, but such relationships have not been explored. METHODS: Consecutively evaluated patients with HFpEF undergoing invasive hemodynamic cardiopulmonary exercise testing were stratified by baseline kidney function to characterize potential differences in pulmonary vascular loading, hemodynamics, cardiopulmonary reserve, and outcomes based upon the presence and severity of kidney dysfunction. RESULTS: Of 925 patients with HFpEF, 319 (34.5%) had eGFR < 60 ml/min/1.73 m2. Patients with more severe kidney dysfunction were older and more likely to have diabetes, atrial fibrillation, and hypertension.. At rest, reduced kidney function was associated with lower hemoglobin, higher biventricular filling pressures, and lower cardiac output, but the severity of kidney dysfunction was most conspicuously associated with worsening PVD, evidenced by increasing pulmonary arterial (PA) pressures due to marked increases in pulmonary vascular resistance (PVR) as kidney dysfunction progressed (median [IQR] 1.3 [0.86, 1.88] to 2.8 [2.0, 3.8] WU from eGFR ≥ 90 to eGFR < 30, p<0.001), along with progressively lower PA compliance (PAC, 4.7 [3.6, 5.8] to 2.2 [1.8, 3.4] ml/mmHg from eGFR ≥ 90 to eGFR < 30, p<0.001). With exercise, differences in the severity of PVD became even more striking, with more severe elevation in PA pressures and PVR, and lower PA compliance, leading to lower transmural left-sided distending pressures, with no difference in exertional PA wedge pressure. Patients with worse kidney dysfunction displayed the most dramatic cardiac output limitations with exercise, which along with more severe anemia and markedly reduced O2 delivery, caused marked impairment in aerobic capacity. Worsening kidney function was associated with a striking gradient of increased risk of a composite of all-cause death and HF hospitalization [ranging from HR 2.38 (95% CI 1.01-5.59) for eGFR 60-90 to HR 16.77 (95% CI 6.65-42.28) for eGFR < 30 (vs. reference eGFR ≥ 90)]. CONCLUSIONS: Kidney dysfunction in patients with HFpEF is characterized by more severe pulmonary vascular disease at rest and with exercise, leading to reduced cardiac output reserve, impaired exercise capacity, and increased risk for adverse events. Further study is warranted to better understand causal relationships between CKD and PVD, and determine whether novel therapies to improve kidney function might target these impairments to improve clinical status."}