Obesity Linked to Kidney Function Decline in HFpEF

Dr Sourabh Sharma, Department of Nephrology, SMS Medical College, Jaipur

In patients with heart failure with preserved ejection fraction, higher BMI, waist circumference, and waist-to-height ratio were each associated with a greater risk of a >30% decline in eGFR, independent of diabetes and hypertension.

Reduced kidney function is quite prevalent among patients with heart failure with preserved ejection fraction (HFpEF) and is associated with worse outcomes. Obesity has a key role in HFpEF pathophysiology, but its impact on kidney function has remained unclear. A study published in Kidney360 investigated this association.

To examine this, researchers analyzed data from the Treatment of Preserved Cardiac Function Heart Failure with Aldosterone Antagonist trial. Obesity was assessed using three measures: waist circumference (WC), body mass index (BMI), and waist-to-height ratio (WHtR).

The primary outcome was a reduction of more than 30% in estimated glomerular filtration rate (eGFR), defined by a single qualifying value. A persistent decline required two consecutive qualifying values. The analyses adjusted for age, sex, diabetes, hypertension, baseline eGFR, and randomization arm.

The study included 1,765 patients with a mean age of 72 years and a median baseline eGFR of 60.8 ml/min/1.73 m². Over a median follow-up of 3.3 years, 687 patients (39%) had a >30% decline in eGFR, and 261 (15%) had a persistent decline. After adjustment, higher BMI (HR 1.10), WC (HR 1.10), and WHtR (HR 1.13) were all associated with a >30% decline in eGFR. None of the obesity measures were significantly associated with a persistent decline in kidney function.

The authors conclude that obesity is linked with decline in kidney function among patients with HFpEF, independent of traditional risk factors such as hypertension and diabetes.

(Reference: Deng L, Tighiouart H, Oka T, Tuttle ML, Downey BC, Rowin EJ, Ho JE, Sarnak M, McCallum W. Association of Obesity with Kidney Function Outcomes in Heart Failure with Preserved Ejection Fraction. Kidney360. 2026 Apr 1. )