eee6d8a82ce6561a1814fa6b7ff0d54d ehaf457.pdf fb27288461b96576726f0e09656491e6079e6c0d ehaf457.pdf a948e70c80faa3f455cb5de0686553d9883dca5ac467775249b37bb3ec1ecb73 ehaf457.pdf Title: Kidney function trajectories before and after hospitalization for heart failure with reduced ejection fraction Subject: DOI: 10.1093/eurheartj/ehaf457; European Heart Journal, 46, 43, 2025-07-30.; Abstract: Background and Aims: Worsening kidney function is a key prognostic factor in heart failure (HF) with reduced ejection fraction (HFrEF). However, associations between kidney function trajectories and HF-related events remain unclear. Methods: Longitudinal changes in estimated glomerular filtration rate (eGFR) before and after a HF-related event, defined as HF hospitalization or HF death, were examined using individual patient data from two clinical trials (EPHESUS and EMPHASIS-HF) and a real-world cohort (BARCELONA). Results: HF-related events occurred in 14.1% of 8587 patients [EPHESUS/EMPHASIS-HF; median follow-up 17.1 (12.4–22.7) months] and 33.8% of 2048 patients [BARCELONA; median 47.0 (18.8–90.6) months]. In EPHESUS and EMPHASIS-HF, patients who experienced an HF-related event had a steeper decline in eGFR in the year preceding the event (average −4.83 mL/min/1.73 m²/year) compared with those Keywords: heart failure with reduced ejection fraction; Kidney function; Cardiorenal syndrome; Mineralocorticoid receptor antagonist; Heart failure hospitalization Author: Masatake Kobayashi Creator: Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64 Producer: PDFlib+PDI 9.0.7p3 (C++/Win64) CreationDate: Tue Nov 11 04:26:56 2025 CET ModDate: Wed Nov 12 10:56:35 2025 CET Custom Metadata: yes Metadata Stream: yes Tagged: yes UserProperties: no Suspects: no Form: AcroForm JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 793.701 pts Page rot: 0 File size: 1334090 bytes Optimized: no PDF version: 1.6 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- QSXJWM+GillSansNova-Book CID TrueType Identity-H yes yes yes 1371 0 QHSZMJ+GillSansNova-Bold CID TrueType Identity-H yes yes yes 1376 0 QYLNKH+GillSansNova-BookItalic CID TrueType Identity-H yes yes yes 1381 0 STPENY+GillSansNova-Heavy CID TrueType Identity-H yes yes yes 1386 0 EUEMOJ+STIXGeneral-Regular Type 1C Custom yes yes yes 1391 0 QGVSJR+GillSansNova-Book Type 1C Custom yes yes yes 12 0 QGVSJR+GillSansNova-Bold Type 1C WinAnsi yes yes yes 17 0 QGVSJR+GillSansNova-Medium Type 1C Custom yes yes no 21 0 QGVSJR+GillSansNova-Book Type 1C Custom yes yes no 25 0 JVMDOK+TimesNewRomanPSMT CID TrueType Identity-H yes yes yes 206 0 WFUTWL+GillSansNova-BoldItalic CID TrueType Identity-H yes yes yes 268 0 RMBHKS+STIXGeneral-Bold Type 1C Custom yes yes yes 273 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-04-25 04:44:13 CEST RepresentationInformation: ehaf457.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-04-24 14:25:15 CEST Size: 1334090 Format: PDF Version: 1.6 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf Profile: Tagged PDF PDFMetadata: Objects: 1467 FreeObjects: 6 IncrementalUpdates: 6 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: false CenterWindow: false DisplayDocTitle: true NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: OneColumn PageMode: UseOutlines Language: en Outlines: Item: Title: Kidney function trajectories before and after hospitalization for heart failure with reduced ejection fraction Destination: head1 Children: Item: Title: Introduction Destination: secehaf457-s1 Item: Title: Methods Destination: secehaf457-s2 Children: Item: Title: Study populations Destination: secehaf457-s2.1 Item: Title: Statistical analysis Destination: secehaf457-s2.2 Item: Title: Results Destination: secehaf457-s3 Children: Item: Title: Patient characteristics Destination: secehaf457-s3.1 Item: Title: Kidney function decline before and after heart failure events Destination: secehaf457-s3.2 Item: Title: Kidney function decline taking into account NYHA Destination: secehaf457-s3.3 Item: Title: Sensitivity analyses Destination: secehaf457-s3.4 Item: Title: Estimated glomerular filtration rate trajectory before and after heart failure events according to randomized treatment assignment (eplerenone/placebo) in EPHESUS and EMPHASIS-HF Destination: secehaf457-s3.5 Item: Title: Discussion Destination: secehaf457-s4 Item: Title: Conclusions Destination: secehaf457-s5 Item: Title: Supplementary data Destination: secehaf457-s6 Item: Title: Declarations Destination: secehaf457-s7 Children: Item: Title: Disclosure of Interest Destination: secehaf457-s7.1 Item: Title: Data Availability Destination: secehaf457-s7.2 Item: Title: Funding Destination: secehaf457-s7.3 Item: Title: Ethical Approval Destination: secehaf457-s7.4 Item: Title: Pre-registered Clinical Trial Number Destination: secehaf457-s7.5 Item: Title: References Destination: reflist Info: Title: Kidney function trajectories before and after hospitalization for heart failure with reduced ejection fraction Author: Masatake Kobayashi Subject: DOI: 10.1093/eurheartj/ehaf457; European Heart Journal, 46, 43, 2025-07-30.; Abstract: Background and Aims: Worsening kidney function is a key prognostic factor in heart failure (HF) with reduced ejection fraction (HFrEF). However, associations betwee渀 欀椀搀渀攀礀 昀甀渀挀琀椀漀渀 琀爀愀樀攀挀琀漀爀椀攀猀 愀渀搀 䠀䘀ⴀ爀攀氀愀琀攀搀 攀瘀攀渀琀猀 爀攀洀愀椀渀 甀渀挀氀攀愀爀⸀ 䴀攀琀栀漀搀猀㨀 䰀漀渀最椀琀甀搀椀渀愀氀 挀栀愀渀最攀猀 椀渀 攀猀琀椀洀愀琀攀搀 最氀漀洀攀爀甀氀愀爀 昀椀氀琀ation rate (eGFR) before and after a HF-related event, defined as HF hospitalization or HF death, were examined using individu愀氀 瀀愀琀椀攀渀琀 搀愀琀愀 昀爀漀洀 琀眀漀 挀氀椀渀椀挀愀氀 琀爀椀愀氀猀 䔀倀䠀䔀匀唀匀 愀渀搀 䔀䴀倀䠀䄀匀䤀匀ⴀ䠀䘀 愀渀搀 愀 爀攀愀氀ⴀ眀漀爀氀搀 挀漀栀漀爀琀 䈀䄀刀䌀䔀䰀伀一䄀⸀ 刀攀猀甀氀琀猀㨀 䠀䘀ⴀ爀攀氀愀琀攀搀 攀ents occurred in 14.1% of 8587 patients [EPHESUS/EMPHASIS-HF; median follow-up 17.1 (12.4–22.7) months] and 33.8% of 2048 pati攀渀琀猀 嬀䈀䄀刀䌀䔀䰀伀一䄀㬀 洀攀搀椀愀渀 㐀㜀⸀　 ㄀㠀⸀㠠ጀ㤀　⸀㘀 洀漀渀琀栀猀崀⸀ 䤀渀 䔀倀䠀䔀匀唀匀 愀渀搀 䔀䴀倀䠀䄀匀䤀匀ⴀ䠀䘀Ⰰ 瀀愀琀椀攀渀琀猀 眀栀漀 攀砀瀀攀爀椀攀渀挀攀搀 愀渀 䠀䘀ⴀ爀攀氀愀琀攀搀 攀瘀攀渀琀 栀愀搀a steeper decline in eGFR in the year preceding the event (average −4.83 mL/min/1.73 m²/year) compared with those Keywords: heart failure with reduced ejection fraction; Kidney function; Cardiorenal syndrome; Mineralocorticoid receptor antagonist; Heart failure hospitalization Creator: Servigistics Arbortext Advanced Print Publisher 11.1.4546/W-x64 Producer: PDFlib+PDI 9.0.7p3 (C++/Win64) CreationDate: Tue Nov 11 04:56:56 CET 2025 ModDate: Wed Nov 12 11:26:35 CET 2025 ID: 0xd4e9ac74654eab28ce15226c77ca7c31, 0xf621cbc92062894487fdb2e3be37ee04 Filters: FilterPipeline: FlateDecode FilterPipeline: DCTDecode Images: Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1066 ImageHeight: 785 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1066 ImageHeight: 818 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1200 ImageHeight: 887 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1200 ImageHeight: 680 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Fonts: Type0: Font: BaseFont: QHSZMJ+GillSansNova-Bold Encoding: Identity-H ToUnicode: true Font: BaseFont: QYLNKH+GillSansNova-BookItalic Encoding: Identity-H ToUnicode: true Font: BaseFont: STPENY+GillSansNova-Heavy Encoding: Identity-H ToUnicode: true Font: BaseFont: QSXJWM+GillSansNova-Book Encoding: Identity-H ToUnicode: true Font: BaseFont: WFUTWL+GillSansNova-BoldItalic Encoding: Identity-H ToUnicode: true Font: BaseFont: JVMDOK+TimesNewRomanPSMT Encoding: Identity-H ToUnicode: true Type1: Font: BaseFont: RMBHKS+STIXGeneral-Bold FontSubset: true FirstChar: 1 LastChar: 3 FontDescriptor: FontName: RMBHKS+STIXGeneral-Bold Flags: Nonsymbolic, ForceBold FontBBox: -1030, -455, 2000, 1055 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: EUEMOJ+STIXGeneral-Regular FontSubset: true FirstChar: 1 LastChar: 9 FontDescriptor: FontName: EUEMOJ+STIXGeneral-Regular Flags: Nonsymbolic FontBBox: -995, -455, 2000, 1055 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true CIDFontType2: Font: BaseFont: JVMDOK+TimesNewRomanPSMT CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: JVMDOK+TimesNewRomanPSMT Flags: Nonsymbolic FontBBox: -568, -307, 2046, 1040 FontFile2: true Font: BaseFont: QHSZMJ+GillSansNova-Bold CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: QHSZMJ+GillSansNova-Bold Flags: Nonsymbolic, ForceBold FontBBox: -476, -276, 1276, 961 FontFile2: true Font: BaseFont: QYLNKH+GillSansNova-BookItalic CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: QYLNKH+GillSansNova-BookItalic Flags: Nonsymbolic, Italic FontBBox: -316, -235, 1219, 950 FontFile2: true Font: BaseFont: STPENY+GillSansNova-Heavy CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: STPENY+GillSansNova-Heavy Flags: Nonsymbolic, ForceBold FontBBox: -504, -287, 1375, 966 FontFile2: true Font: BaseFont: QSXJWM+GillSansNova-Book CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: QSXJWM+GillSansNova-Book Flags: Nonsymbolic FontBBox: -420, -251, 1219, 950 FontFile2: true Font: BaseFont: WFUTWL+GillSansNova-BoldItalic CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: WFUTWL+GillSansNova-BoldItalic Flags: Nonsymbolic, Italic, ForceBold FontBBox: -404, -250, 1219, 960 FontFile2: true XMP: uuid:25551b35-435f-4ba3-a2ba-5213035ce5d9 uuid:FBCFD43D-72A1-4A91-257D-958E0FE37D16 True heart failure with reduced ejection fraction; Kidney function; Cardiorenal syndrome; Mineralocorticoid receptor antagonist; Heart failure hospitalization PDFlib+PDI 9.0.7p3 (C++/Win64) application/pdf 10.1093/eurheartj/ehaf457 en Oxford University Press Kidney function trajectories before and after hospitalization for heart failure with reduced ejection fraction Masatake Kobayashi Antoni Bayes-Genis Kevin Duarte John J.V. McMurray João Pedro Ferreira Stuart J. Pocock Dirk J. Van Veldhuisen Josep Lupón Bertram Pitt Faiez Zannad Nicolas Girerd DOI: 10.1093/eurheartj/ehaf457; European Heart Journal, 46, 43, 2025-07-30.; Abstract: Background and Aims: Worsening kidney function is a key prognostic factor in heart failure (HF) with reduced ejection fraction (HFrEF). However, associations between kidney function trajectories and HF-related events remain unclear. Methods: Longitudinal changes in estimated glomerular filtration rate (eGFR) before and after a HF-related event, defined as HF hospitalization or HF death, were examined using individual patient data from two clinical trials (EPHESUS and EMPHASIS-HF) and a real-world cohort (BARCELONA). Results: HF-related events occurred in 14.1% of 8587 patients [EPHESUS/EMPHASIS-HF; median follow-up 17.1 (12.4–22.7) months] and 33.8% of 2048 patients [BARCELONA; median 47.0 (18.8–90.6) months]. In EPHESUS and EMPHASIS-HF, patients who experienced an HF-related event had a steeper decline in eGFR in the year preceding the event (average −4.83 mL/min/1.73 m²/year) compared with those © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. heart failure with reduced ejection fraction Kidney function Cardiorenal syndrome Mineralocorticoid receptor antagonist Heart failure hospitalization Journal European Heart Journal © The Author(s) 2025. 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