Chronic kidney disease and the risk of heart failure in men.

BACKGROUND The relations between chronic kidney disease (CKD) and incident heart failure remain unclear. METHODS AND RESULTS We related CKD to incident nonfatal heart failure and cardiovascular (CVD) death (as separate and combined end points) in 10 181 male participants (mean age, 67 years). Kidney function was assessed by estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease equation in clinically relevant categories of <60 and ≥60 mL · min(-1) · 1.73 m(-2) (referent) and <45, 45 to 60, 60 to 90, and ≥90 mL · min(-1) · 1.73 m(-2) (referent). During follow-up (mean, 10.1 years; range, 0.03 to 12.2), 439 developed heart failure and 832 had CVD death/heart failure. In multivariable models, men with eGFR <60 mL · min(-1) · 1.73 m(-2) had a 2-fold risk of heart failure (95% confidence interval, 1.62 to 2.56, P<0.0001) compared with referent category. The hazard ratio (with corresponding 95% confidence interval) for development of heart failure according to eGFR categories of 60 to 90, 45 to 60, and <45 mL · min(-1) · 1.73 m(-2) compared with referent category were 1.24 (0.98 to 1.56), 2.58 (1.91 to 3.49), and 1.52 (0.92 to 2.76), respectively. In the analyses restricted to subgroup of nondiabetic individuals and normotensive individuals at baseline (n=7545), men with eGFR <60 mL · min(-1) · 1.73 m(-2) had a 2.2-fold risk of heart failure (95% confidence interval, 1.66 to 2.95), compared with men with eGFR ≥60 mL · min(-1) · 1.73 m(-2). Additionally, risk of heart failure or CVD death was >2.5-fold higher among individuals with eGFR 45 to 60 and <45 mL · min(-1) · 1.73 m(-2), compared with referent category. CONCLUSIONS Moderate level of CKD, even in absence of diabetes and hypertension at baseline, is associated with a higher risk of development of heart failure and CVD death/heart failure in men.